体外膜氧合在肺损伤治疗中的应用

Application of extracorporeal membrane oxygenation in the treatment of lung injury

目的观察体外膜氧合(ECMO)在肺损伤中的治疗效果。方法回顾性分析11例因肺损伤采用ECMO治疗的成人患者临床资料,对治疗过程中血气数据以及生存率进行比较。结果11例患者均因肺损伤或肺炎入院,经常规治疗无效(氧合指数<100 mm Hg)进而实施静脉-静脉或静脉-动脉ECMO治疗。ECMO运行前氧合指数79.88(44.00~85.00)mm Hg,ECMO运行后,氧分压较运行前显著提升,治疗期间输注红细胞悬液1200~7560 ml,运行期间同时采用肺保护性通气策略(低潮气量4~6 ml/kg)、呼气末正压(11.63±2.20)cmH2O进行机械通气。ECMO运行时间为5.50~741.00 h,90 d观察期内存活5人(45.45%),死亡6人(54.55%)。ECMO运行前,生存组较死亡组具有更低的乳酸水平,两组年龄差异具有边缘显著性。结论ECMO可显著改善肺损伤患者氧合,患者ECMO运行前的乳酸水平可影响肺损伤患者的存活率。

Objective To observe the therapeutic effect of extracorporeal membrane oxygenation(ECMO)in lung injury.Methods Eleven adult patients with lung injury that required ECMO support were collected and the data of blood gas and survival rate during treatment were analyzed retrospectively.Results Eleven patients were admitted to the hospital due to lung injury or pneumonia.They received conventional treatment at first which was invalid(Oxygenation index,PaO2/FiO2<100 mm Hg),and then VV-or VA-ECMO was implemented.Oxygenation index before ECMO support was 79.88(44.00-85.00)mmHg,and PO2 was significantly im⁃proved after receiving ECMO treatment.Infusion of red blood cell was 1200-7560 ml and lung protective ventilation strategy(low tidal volume and positive end expiratory pressure(PEEP)(11.63±2.20 cmH2O))was used during ECMO treatment.ECMO running time was 5.50-741.00 hours.5 people survived(45.45%)but 6 people died(54.55%)during the observation period of 90 days.Before ECMO running,the survival group had a lower lactate level than the death group.The age difference between the two groups was mar⁃ginally significant.Conclusion ECMO can significantly improve oxygenation in patients with lung injury.The lactic acid level before ECMO support is significantly associated with survival rate of the patients.