体外膜肺氧合治疗ARDS期间氧代谢变化与预后的关系

The Relationship Between Oxygen Metabolism and Prognosis in Critical Acute Respiratory Distress Syndrome patients treated by Extracorporeal Membrane Oxygenation

目的探讨体外膜肺氧合（ECMO）治疗重症急性呼吸窘迫综合征（ARDS）期间的氧代谢、乳酸水平的变化与预后的关系。方法回顾性分析17例机械通气效果不佳、应用体外膜肺氧合治疗的急性呼吸窘迫综合征患者，以应用ECMO后30d为观察终点，分为存活组和死亡组，统计分析治疗前后两组患者的氧代谢、血乳酸水平变化，分析各项指标与预后的关系。结果应用体外膜肺氧合后，患者氧代谢情况明显改善，10例患者治愈，7例死亡。两组患者应用ECMO后氧供、氧耗均明显增加，存活组患者的氧摄取率基本维持在正常水平，乳酸水平呈下降趋势。死亡组患者的氧摄取率明显提高，乳酸水平未见明显下降。结论体外膜肺氧合治疗重症急性呼吸窘迫综合征，氧摄取率维持在正常水平、乳酸水平逐渐下降提示预后良好。

Objective To obtain oxygen metabolic parameters and lactic acid concentration in Acute Respiratory Distress Syndrome（ARDS） patients treated by Extracorporeal Membrane Oxygenation （ECMO） , and to evaluate relationship between these variables and prognosis. Methods 17 ARDS patients treated by ECMO after failure of conventional ventilation therapy, were analyzed retrospectively. All the patients were divided into survival group and non-survival group according to the situation in the 30th day after ECMO. The oxygen metabolic paraters,lactic acid concentration were calculated and measured. Results 10 patients survived,7 died. Oxygen delivery（ DO2 ）, Oxygen consumption（ VO2 ）were improved after ECMO in both groups. Oxygen extraction rate（ ERO2 ）was mantained within normal range, lactic acid concentration decreased in survival group. ERO2 was improved, lactic acid concentration did not decreased in non-survival guoup. Conclusion In critical ARDS patients treated by ECMO;ERO2 within noumal range and decreasing trend in lactic acid concentration predict good prognosis.