应用体外膜肺氧合对肺移植受者围手术期凝血功能的影响

Effects of extracorporeal membrane oxygenation on coagulation during lung transplantation

目的观察应用体外膜肺氧合（ECMO）辅助转流对肺移植受者围手术期凝血功能的影响。方法回顾性分析2007年1月至2012年3月接受双肺移植的受者40例，根据是否应用ECMO将受者分为ECMO组（28例）与对照组（12例），术中监测激活全血凝固时间，记录术中出血量，术后静脉采血检测血浆凝血酶原时间，活化部分凝血活酶时间，凝血时间及血浆纤维蛋白原等凝血功能指标。结果ECMO组受者术中出血量为（1575．00±1631．56）ml、PT为（13．18±1．89）S、APTT为（33．16±4．59）s及凝血时间为（18．05±1．65）S，对照组则分别为（1454．55±738．06）ml、（13．65±1．83）s、（33．76±8．41）s及（17．74±2．38）S，两组比较，差异均无统计学意义（P〉0．05）。术后ECMO组出现ECMO伤口感染2例，经治疗后好转出院，1例出现股动脉血栓形成，经溶栓治疗后好转出院。结论肺移植围手术期使用ECMO未引起术中失血增多或术后凝血功能障碍，可提高手术成功率及改善预后，但有可能导致局部血栓形成的风险增加。

Objective To observe the effects of extracorporeal membrane oxygenation （ECMO） on coagulation during lung transplantation. Method Forty cases of end stage lung diseases received bilateral sequential single lung transplantation during July 2007 and Mar. 2012. The patients were divided into two groups in terms of ECMO. ECMO was applied before lung transplantation if needed. The amount of bleeding during surgery was recorded. The venous blood samples were collected during and after operation for the measurements of the following parameters： activated whole blood clot time （ACT）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （TT） and plasma fibrinogen （Fg）. Result The coagulation and the amount of bleeding showed no significant difference between the two groups. Wound infection occurred in 2 patients where the ECMO tube was inserted and femoral arterial thrombosis in one patient. All of the three patients were cured and discharged. Conclusion ECMO didn＇t cause excessive bleeding or coagulation dysfunction during lung transplantation, vet it maybe increase the occurrence of local thrombosis.