静脉-动脉-静脉体外膜肺氧合治疗8例危重症患者的临床分析

Clinical analysis of eight critically ill patients treated with veno-arterio-venous extracorporeal membrane oxygenation

目的 探讨本院应用静脉-动脉-静脉体外膜肺氧合(V-A-V ECMO)救治各类危重症患者的指征及切换时机。方法 回顾性分析本院重症医学科(ICU)于2016年4月至2022年4月应用V-A-V ECMO救治的8例危重症患者的临床资料。结果 8例患者中男性6例,女性2例,平均年龄(60.25±15.02)岁。8例患者行ECMO前急性生理与慢性健康状况评分Ⅱ(30.75±10.50)分,序贯器官衰竭评分(13.75±2.92)分;ECMO时长(89.00±72.43)h;4例患者死亡。8例患者中有3例V-A模式转换为V-A-V模式,1例V-V模式转换为V-A-V模式,4例患者初始即选择了V-A-V模式。结论 V-A-V ECMO作为一种特殊ECMO策略,可以用于治疗同时存在呼吸循环衰竭的患者,V-A-V模式的转换应根据患者需要的支持情况而定,而在特定的患者中,尤其是初始病因不明者,V-A-V模式也可以考虑作为初始设置。

Objective To investigate the indications and conversion time of veno-arterio-venous extracorporeal membrane oxygenation(V-A-V ECMO) for critically ill patients in our hospital. Methods The clinical data of 8 critical patients treated by V-A-V ECMO in the Intensive Care Unit(ICU) of our hospital from April 2016 to April 2022 were analyzed retrospectively. Results A total of 8 patients had the average age(60.25±15.02) years, including 6 men and 2 women, were supported with V-A-V ECMO. The acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score and sequential organ failure assessment(SOFA) score before ECMO were(30.75±10.50) scores and(13.75±2.92) scores. Mean duration of V-A-V ECMO support was(89.00±72.43)h. 4 cases died. Among the 8 patients, 3 V-A mode switched to V-A-V mode, 1 V-V mode switched to V-A-V mode, and 4 patients initially chose V-A-V mode. Conclusions V-A-V ECMO mode, as a specific ECMO strategy, can be used to treat patients with co-existing respiratory and circulatory failure. V-A-V mode conversion should be based on the patient′s need, and V-A-V mode can also be considered as an initial setting in certain patients, especially those with unknown etiology.