体外膜肺氧合下重症肺炎患者微创气管切开4例经验总结

Summary of 4 cases of minimally invasive tracheotomy for severe pneumonia under extracorporeal membrane oxygenation

目的总结4例重症肺炎患者静脉-静脉体外膜肺氧合(VV-ECMO)下床边微创气管切开救治经验,为重症肺炎患者气道管理提供可借鉴的实例.方法采用回顾性研究方法.选择2022年11月至2023年3月就诊于山东第一医科大学附属省立医院重症监护病房(ICU)进行体外膜肺氧合(ECMO)的4例重症肺炎患者作为研究对象,收集患者的一般情况、入住ICU前后的影像学检查、ECMO前后生化指标的变化、床边微创气管切开等临床资料.根据病情变化对患者进行床旁气管切开术辅助通气治疗.观察患者病情变化及预后.结果本院4例重症肺炎患者持续VV-ECMO状态下进行床旁气管切开术辅助通气治疗,术后血氧饱和度均维持在0.98~1.00,气道清理排痰通畅,生命体征平稳,后续逐步撤机.结论在重症肺炎的救治过程中,安全快速完成持续ECMO状态下重症肺炎患者床边微创气管切开是耳鼻咽喉头颈外科及ICU医护共同面临的新挑战.本研究报告的4例VV-ECMO治疗后床旁气管切开术的成功案例,提示床边微创气管切开技术可以安全快速地辅助气道管理,为目前重症肺炎和急性呼吸道传染疾病的救治提供了更多有益经验.

Objective To summarize the experience of minimally invasive tracheotomy under veno-venous extracorporeal membrane oxygenation(VV-ECMO)in 4 cases of severe pneumonia,and to provide examples for airway management of severe pneumonia patients.Methods A retrospective study method was conducted.Four cases of severe pneumonia patients who underwent extracorporeal membrane oxygenation(ECMO)at the intensive care unit(ICU)of Shandong Provincial Hospital Affiliated to Shandong First Medical University from November 2022 to March 2023 were selected as the study subjects,clinical data on the general conditions,imaging examinations before and after admission to ICU,changes in biochemical indexes before and after ECMO technique,and the performance of bedside minimally invasive tracheotomy were collected.Bedside tracheotomy was performed to assist ventilation for patients according to the change of condition.The changes and prognosis of the patients were observed.Results Four patients with severe pneumonia were treated with bedside tracheotomy-assisted ventilation in the state of continuous VV-ECMO,the oxygen saturation was maintained between 0.98-1.00,the airway was cleared and sputum evacuation was smooth,the vital signs were stable after the operation,and the machine was gradually withdrawn.Conclusion During the treatment of severe pneumonia,the safe and rapid completion of bedside minimally invasive tracheotomy in patients with severe pneumonia under continuous VV-ECMO is a new challenge shared by doctors and nurses of otorhinolaryngology,head and neck surgery,and critical care emergency care unit.The four successful cases of bedside tracheotomy after VV-ECMO treatment we report suggest that bedside minimally invasive tracheotomy can safely and rapidly assist airway management,and may provide more useful experiences for the treatment of severe pneumonia and possible new acute respiratory infectious diseases in the future.