ECMO在重症腺病毒肺炎救治中的应用

Application of ECMO in the treatment of severe adenovirus pneumonia

腺病毒是引起儿童呼吸道感染的常见病原之一,可造成重症肺炎.重症腺病毒肺炎起病急,进展快,并发症多,但无特效治疗手段,病死率高.机械通气是救治重症腺病毒肺炎的重要呼吸支持手段,而呼吸机相关性肺损伤是机械通气治疗时不可避免的弊端.体外膜肺氧合( ECMO)可对心肺功能进行长时间的替代和支持,减少呼吸机相关性肺损伤的发生,并能改善氧合.当重症腺病毒肺炎患儿出现呼吸衰竭或急性呼吸窘迫综合征,经常规治疗不能改善低氧血症,或出现气漏等并发症时,应考虑应用ECMO治疗.但国内相关研究不多,重症腺病毒肺炎ECMO呼吸支持的模式选择、介入时机、管理要点等有待进一步积累经验.

Adenovirus is one of the common pathogens causing respiratory tract infection in children,which can cause severe pneumonia.Severe adenovirus pneumonia has an acute onset,rapid progress,and many complications,but there is no specific treatment and the mortality rate is high.Mechanical ventilation is an important means of respiratory support for the treatment of severe adenoviral pneumonia,and ventilatorassociated lung injury is an inevitable drawback of mechanical ventilation.ECMO can replace and support cardiopulmonary function for a long time,reduce the occurrence of such damage,and improve oxygenation.When patients with severe adenovirus pneumonia develop respiratory failure or ARDS,and conventional treatment fails to improve hypoxemia,or accompanied by air leakage and other complications,ECMO treatment should be considered.However,there are few relevant studies in China,and further experience needs to be accumulated in the selection of respiratory support modes,intervention opportunities and management points of ECMO respiratory support for severe adenovirus pneumonia.