体外膜肺氧合在甲型H1N1流感患者肺功能支持中的应用

The use of extracorporeal membrane oxygenation in sustaining pulmonary function patients with influenza A H1N1

目的总结甲型H1N1流感危重患者体外膜肺氧合（ECMO）支持治疗的方法和经验。方法5例甲型H1N1流感危重症患者均在呼吸机辅助吸入氧浓度（FiO2）1．00时，动脉血氧饱和度（SaO2）0．70～0．85。男3例，女2例。5例患者分别经股静脉-颈内静脉置管采用V—V模式ECMO转流进行肺功能辅助，膜肺氧流量与血流量比为2～1：1，吸入氧浓度0．21～1．00；呼吸机氧浓度0．30～0．70，呼吸末正压（PEEP）5～10cmH2O；活化凝血时间（ACT）维持在160～250S；在ECMO撤离观察期间关闭膜肺气体，动、静脉血氧饱和度和血气无明显变化后即可停ECMO并拔管，继续呼吸机辅助。结果5例患者辅助时间48～330h，平均178．2h；ECMO辅助流量2．4～4．0L／min；EcM0撤离观察时间4～24h。4例患者顺利撤离ECMO过渡到呼吸机辅助呼吸，1例患者家属放弃治疗而死亡。结论股静脉-颈内静脉置管V—V模式ECMO转流可以为甲型H1N1流感危重患者提供有效的肺功能辅助，为患者过渡到适宜呼吸机辅助的状态争取时间。

Objective To summarize the clinical method and initial experience of extracorporeal membrane oxygenation （ECMO） supportive treatment in influenza A H1N1 serious patients. Methods In 5 critically ill patients with influenza A H1N1, their arterial oxygen saturation was 0.70 to 0.85 with oxygen concentration （FiO2） 1.00 under mechanical ventilation. In these 5 patients, 3 males and 2 females, vein-vein mode ECMO bypass （femoral vein-internal jugular vein） was. carried out to assist pulmonary function. The ratio between ECMO oxygen flow and blood flow was 2 - 1 ： 1, FiO2 was 0.21 to 1.00, FiO2 for mechanical ventilation was 0. 30 to 0.70, and positive end expiratory pressure （PEEP） was 5 - 10 cm H2O （1 cm H2O= 0.098 kPa）. Activated coagulation time （ACT） was maintained at 160- 250 s. When artery oxygen saturation and artery-venous blood gas became normal on discontinuation of ECMO, ECMO was weaned, and venous cannulas were removed. Mechanical ventilation was continued. Results In 5 patients the assisting time of ECMO was 48 - 330 hours, the mean duration was 178.2 hours. ECMO assisted flow was 2.4 - 4.0 L/min. The observation time after stoppage of ECMO was 4 - 24 hours. Four patients were weaned from ECMO, with continuation of assisted respiration successfully. One patient died because the family member gave up hope and the treatment was stopped. Conclusion Vein-vein mode ECMO bypass through femoral vein-internal jugular vein can offer effective aid to pulmonary function in influenza A H1N1 patients who are critically ill. The strategy can win time for the patients to be able to continue mechanical ventilation treatment.