体外膜氧合治疗甲型H1N1流感危重症合并呼吸衰竭4例临床疗效观察

Application of extracorporeal membrane oxygenation in critical influenza type H1N1 infection patients with respiratory failure:report of 4 cases

目的探讨体外膜氧合(extracorporeal membrane oxygenation,ECMO)治疗在危重症甲型H1N1流感患者救治中的作用。方法自2009年10月3日至12月25日,北京地坛医院共收治危重症甲型H1N1流感患者58例,其中实施ECMO治疗患者4例。结果 4例患者中,3例顺利撤离ECMO装置,脱机率为75%,其中2例康复出院,2例死亡。ECMO治疗后,氧合指数由48～77mm Hg[1mm Hg=0.133kPa,平均(59.8±12.4)mm Hg]升高至122～254mm Hg[平均(191.8±85.1)mm Hg]。主要并发症有出血和渗血3例,导管感染2例,膜肺血栓2例。结论对于危重症甲型H1N1流感合并急性呼吸窘迫综合征的患者,在经高呼吸机条件仍不能纠正缺氧状况的情况下,ECMO可作为一种有效的治疗手段加以应用。

Objective To evaluate the effectiveness of extracorporeal membrane oxygenation （ECMO） in the treatment of critical influenza type H1N1 infection patients. Methods We treated 4 critical influenza type H1N1 infection patients with ECMO during the period of Oct. 3 to Dec. 25,2009. Results After the ECMO treatment,3 of the 4 patients evacuated from ECMO devices successfully. Two patients died,and two patients discharged from hospital. During the treatment,the oxygenation index increased from 48～77mmHg （mean 59.8mmHg） to 122～254mmHg （mean 191.8mmHg）. The complications included hemorrhage,catheter related infection,and throm-bosis in oxygenation membrane. Conclusion ECMO support may be helpful for some influenza infection patients with severe pulmonary failure refractory to conventional management.