ECMO辅助在肺移植围手术期的效果:单中心回顾性研究

Perioperative effects of ECMO assistance in lung transplantation:a single-center retrospective study

目的探讨体外膜肺氧合(ECMO)在肺移植手术麻醉中的应用,观察其对改善麻醉效果和预后的作用。方法回顾性分析我院2017年6月至2023年3月行单肺移植或双肺移植的70例患者。根据ECMO的应用将患者分为V-V组(34例)、V-A组(14例)和非ECMO组(22例)。比较三组围手术期相关临床资料,包括手术方式、手术时间、术中血流动力学指标、术中出血量和尿量、术后ECMO撤机时间、拔管时间,以及再次插管、二次开胸止血等不良事件。结果三组患者人口学资料和病因学特征差异无统计学意义(P>0.05)。与非ECMO组比较,V-V组和V-A组术中平均肺动脉压(mPAP)、动脉血氧分压(PaO2)及二氧化碳分压(PaCO_(2))较优(P<0.05),但术中出血量更多(P<0.05)。V-V组和V-A组住院时间更短(P<0.05),再次插管几率更小(P<0.05)。结论ECMO可优化肺移植手术麻醉效果,缩短住院时间,提高危重患者生存率。但应注重其并发症的防范。ECMO是一种值得在肺移植麻醉中推广的有用辅助手段。

Objective To explore the application of extracorporeal membrane oxygenation(ECMO)in lung transplant surgery anesthesia,and observe its effect on improving anesthesia effect and prognosis.Methods A retrospective analysis of 70 patients who underwent single or bilateral lung transplantation in our hospital from June 2017 to March 2023 was performed.According to the use of ECMO,the patients were divided into the V-V group(34 cases),the V-A group(14 cases),and the non-ECMO group(22 cases).Perioperative clinical data of the three groups were compared,including operation mode,operation time,intraoperative hemodynamic indexes,intraoperative blood loss and urine volume,postoperative ECMO withdrawal time,extubation time,and adverse events such as reintubation and secondary thoracotomy for hemostasis.Results There was no significant difference in demographic data and etiological characteristics among the three groups(P>0.05).Compared with the non-ECMO group,the mean pulmonary artery pressure(mPAP),partial oxygen pressure(PaO_(2))and partial carbon dioxide pressure(PaCO_(2))in the V-V and V-A groups were better(P<0.05),but the intraoperative blood loss was more(P<0.05).The V-V and V-A groups had shorter hospital stays(P<0.05)and were less likely to be intubated again(P<0.05).Conclusion ECMO can optimize the anesthesia effect of lung transplant surgery,shorten the hospital stay,and improve the survival rate of critically ill patients.But we should pay attention to the prevention of its com-plications.ECMO is a useful adjunct to anesthesia for lung transplantation.