体外膜肺氧合治疗重症急性呼吸窘迫综合征疗效及对患者预后的影响

Curative effect of extracorporeal membrane oxygenation on severe acute respiratory distress syndrome and its prognosis of patients

目的:探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗重症急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的疗效及对患者预后的影响。方法:选取2015年9月至2019年9月南京大学医学院附属鼓楼医院收治的60例重症ARDS患者为对象,按照随机数字法分为对照组(n=30)和观察组(n=30),对照组给予呼吸机通气治疗,观察组给予ECMO治疗,比较2组血流动力学指标[心率(heart rate,HR)、肺动脉压(pulmonary arterial pressure,PAP)、心排血数(cardiac output index,CI)]、血气指标[氧分压(partial pressure of oxygen,PaO_(2))、二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))、血氧饱和度(blood oxygen saturation,SaO_(2))、混合静脉血氧分压(mixed venous oxygen partial pressure,PvO_(2))、混合静脉二氧化碳分压(mixed venous carbon dioxide partial pressure,PvCO_(2))、混合静脉血氧饱和度(mixed venous oxygen saturation,SvO_(2))]、氧代谢指标[氧耗(oxygen consumption,VO_(2))、氧输送(oxygen delivery,DO_(2))、氧摄取率(oxygen extraction rate,ERO_(2))、血乳酸(blood lactic acid,Lac)]、并发症发生率、撤机成功率及存活率。结果:治疗后观察组HR、PAP、CI均高于对照组(P<0.05);治疗后观察组PaO_(2)、SaO_(2)、PvO_(2)、SvO_(2)均高于对照组,PaCO_(2)、PvCO_(2)低于对照组(P<0.05);治疗后观察组DO_(2)、VO_(2)、ERO_(2)均高于对照组,Lac低于对照组(P<0.05);观察组并发症发生率低于对照组(6.67%vs.26.67%;P<0.05);观察组成功撤机率和3个月内存活率高于对照组,但2组比较差异无统计学意义(P>0.05)。结论:ECMO治疗重症ARDS患者疗效显著,可改善氧代谢,维持血流动力学稳定,降低并发症发生率和病死率,可作为临床治疗重症ARDS的有效手段。

Objective:To explore the curative effect of extracorporeal membrane oxygenation(ECMO)on severe acute respiratory distress syndrome(ARDS)and its influences on prognosis of patients.Methods:Sixty patients with severe ARDS who were admitted to the hospital from September 2015 to September 2019 were enrolled as study objects,and they were randomized into control group(n=30)and observation group(n=30).The control group was treated with ventilator,while the observation group was treated with ECMO.The hemodynamic indexes[heart rate(HR),pulmonary arterial pressure(PAP),cardiac output index(CI)],blood gas indexes[partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),blood oxygen saturation(SaO_(2)),mixed venous oxygen partial pressure(PvO_(2)),mixed venous carbon dioxide partial pressure(PvCO_(2)),mixed venous oxygen saturation(SvO_(2))],oxygen metabolism indexes[oxygen consumption(VO_(2)),oxygen delivery(DO_(2)),oxygen extraction rate(ERO_(2)),blood lactic acid(Lac)],incidence of complications,success rate of weaning and survival were compared between the two groups.Results:After treatment,HR,PAP and CI in observation group were higher than those in control group(P<0.05).After treatment,PaO_(2),SaO_(2),PvO_(2) and SvO_(2) in observation group were higher than those in control group,while PaCO_(2) and PvCO_(2) were lower than those in control group(P<0.05).After treatment,DO_(2),VO_(2) and ERO_(2) were higher in observation group than control group,while Lac was lower than control group(P<0.05).The incidence of complications in observation group was lower than that in control group(6.67%vs.26.67%)(P<0.05).The success rate of weaning and 3-month survival rate in observation group were higher than those in control group,without significant difference(P>0.05).Conclusion:ECMO has a significant curative effect on severe ARDS patients,which can improve oxygen metabolism,and maintain hemodynamics stability,reduce incidence of complications and mortality,and can be applied as an effective means for clinical treatment of severe ARDS.