体外膜肺氧合在临床肺移植中的应用

Application of ECMO in lung transplantation

目的总结体外膜肺氧合（ECMO）技术在临床肺移植中应用的经验。方法45例肺移植受者，年龄（50．5±8．6）岁（16-74）岁。原发病为肺纤维化合并肺动脉高压32例，慢性阻塞性肺病4例，矽肺2例，肺结核2例，弥漫性细支气管炎1例，支气管扩张2例，以及原发性肺动脉高压2例。其中3例受者在术前经股动、静脉切开置ECMO管道，分别维持13、19和6d后，在ECMO支持下接受了肺移植手术；40例受者在术中应用了ECMO辅助；2例未在体外循环下接受肺移植的受者，因原发性移植物功能丧失（PGD）于术后行ECMO辅助支持。结果40例术中应用ECMO者，37例于术毕顺利撤除ECMO，术中辅助流量为（2．8±0．6）L／min，辅助持续时间为（7．7±0．9）h，存活31例；3例术后继续使用ECMO，直至血流动力学稳定，其中2例分别于术后36h和7d时顺利撤除，另1例术后使用ECMO维持5d后出现急性肾功能衰竭，术后2周时死于多器官功能衰竭。2例术中无体外循环辅助受者和其余3例术中辅助受者因术后发生PGD或急性心力衰竭，而初次或再次使用ECMO，辅助流量分别为（2．5±0．3）L／min和（2．6±0．4）L／min，辅助持续时间分别为（53．5±21．9）h和（88．7±45．9）h，其中3例治愈出院，2例因多器官功能衰竭而死亡。所有受者均未发生明确与ECMO相关的并发症。结论ECMO是肺移植围手术期支持的重要辅助工具，对于降低等待肺移植过程中的死亡率、稳定术中血流动力学、改善术后严重呼吸功能障碍以及原发性移植物功能不良，可以提供良好的辅助功能。

Objective To summarize the experiences of extracorporeal membrane oxygenation （ECMO） technique in human lung transplantation. Methods ECMO was used in 45 patients undergoing lung transplantation. There were 32 cases of dilated pulmonary fibrosis and pulmonary hypertension, 4 cases of chronic obstructive pulmonary disease, 2 cases of pneumosilicosis, 2 cases of phthisis, one case of diffuse panbronchiolitis, 2 cases of bronchiectasis and 2 cases of primary pulmonary hypertension. In 3 patients, ECMO conduit was used as a bridge to the lung transplantation for 13, 19 and 6 days respectively before operation, and ECMO support was done after the operation. In 40 patients ECMO support was done during operation. In 2 patients without using cardiopulmonary bypass, ECMO support was done after operation because of primary graft dysfunction. Results In 40 patients undergoing ECMO support during operation, the ECMO conduit was removed in 37 patients immediately after the operation. ECMO mean blood flow was （2. 8 ＋ 0. 6） L/min, running time was （7. 7 ＋ 0. 9） h, and 31 patients survived. In 3 patients undergoing postoperative ECMO support, ECMO was removed in 2 cases at 36th h and 6th day after the operation respectively, and the remaining one died from acute renal failure 2 weeks after the operation though the continuing hemofiltration was applied through ECMO conduit. In 2 patients without using cardiopulmonary bypass and 3 patients using ECMO during operation, ECMO support was used initially or again after operation because of PGD or acute heart failure. Three patients were cured, and 2 patients were died from multiple system organ failure. Conclusion ECMO is an important auxiliary tool in lung transplantation for preoperative, intraoperative and postoperative supports. As the transition bridge to recipients, ECMO can be used for preoperative supports; during operation, it can stabilize the haemodynamics, and postoperation, it can improve severe pulmonary function dysfunction and PGD.