体外膜肺氧合在双肺移植围术期应用报告

Clinical Experience of Extracorporeal Membrane Oxygenation for Sequential Double Lung Transplantation

目的 总结序贯式双肺移植术中应用体外循环 (CPB)和术后体外膜肺氧合 (ECMO)支持的经验。方法 对一例 5 0岁男性双肺弥漫性肺间质纤维化伴感染的患者施行序贯式双肺移植。手术中第一侧肺移植完成后不久血流动力学不稳定 ,血气分析恶化 ,紧急行股动脉 -股静脉CPB ,并在术后转为ECMO ,共 6 7小时。结果 患者因进行性肺实变 ,多脏器功能衰竭死亡。结论 肺移植手术如需要应用CPB应在血流动力学状况恶化前进行 ;ECMO对凝血机制的影响以及ECMO血流量对肺循环的影响还需要进一步研究 ;进行ECMO过程中 。

OBJECTIVE To conclude the clinical experience of extracorporeal membrane oxygenation (ECMO) for sequential double lung transplantation. METHODS Objective Methods One male was undervent sequential double lung transplantation. After first lung transplanted, hemodynamic unstable and hypooxemia force to receive CPB. And get to ECMO for respiratory support for next 67 hours.RESULTS This patients was died for multi organ failure though ECMO system was still contact.CONCLUSION If CPB is needed for lung transplantation, the time for that would better set up before hemodynamic unstable. The coagulation management and ECMO flow rate need more study for better result. Good teamwork is most important to get an success ECMO.