| 摘要: |
| 目的 分析近年我院体外膜肺氧合（ECMO）治疗的临床结果和经验，总结应用ECMO救治各类危重患者的方法、时机及适应证。方法 回顾性分析我院2014年1月至2016年11月间18例行ECMO救治的危重症患者的临床资料（原发病、辅助模式、辅助时间），比较各类危重症患者应用ECMO救治的脱机率和存活率，分析各类危重症患者的存活因素及死亡原因。结果 18例危重患者中采用静脉-动脉辅助模式（VA-ECMO）12例、静脉-静脉辅助模式（VV-ECMO）4例、静脉-动脉-动脉辅助模式（VAA-ECMO）2例，共成功脱机7例（38.9%），存活5例（27.8%）。ECMO救治循环衰竭患者的脱机率为62.5%（5/8），存活率为37.5%（3/8）；救治呼吸衰竭患者的脱机率和存活率均为20%（2/10），重度烧伤后、创伤后及手术后成人呼吸窘迫综合征（ARDS）的6例患者无一例存活。由肺部疾病导致ARDS患者（HR=12.3，95% CI：2.2~69.9；P<0.01）和循环衰竭患者（HR=4.6，95% CI：1.1~19.5；P<0.05）的存活率均高于非肺部原因继发的ARDS患者，而循环衰竭患者与肺部疾病导致ARDS患者的存活率差异无统计学意义（P>0.05）。结论 及时选择ECMO救治时机、完善建立流程、积极治疗原发病，以及防止相关并发症的发生是ECMO救治成功的关键，而院方应急通道的建立和多学科多部门合作的ECMO救治梯队的形成是ECMO成功的保障。 |
| 关键词: 胸心血管外科学 体外膜肺氧合 危重症患者 适应证 存活率 |
| DOI：10.16781/j.0258-879x.2018.01.0105 |
| 投稿时间：2017-09-18修订日期：2017-11-28 |
| 基金项目:无 |
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| Clinical analysis of extracorporeal membrane oxygenation in treatment of critical patients: a report of 18 cases |
| YANG Fan,WANG Jun*,DING Jin-kui,FAN Mei-zhen,CHEN Jia-yi,WU Jun,CHEN Xiao-fang |
(Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the recent clinical results and experience of extracorporeal membrane oxygenation (ECMO) in treating critical patients, so as to summarize the methods, timing and indications of ECMO treatment. Methods We retrospectively analyzed the clinical data (primary disease, supportive mode, adjuvant time and so on) of 18 critical patients treated with ECMO from Jan. 2014 to Nov. 2016 in our hospital, compared the offline rate and success rate of different kinds of critical patients, and analyzed the survival factors and causes of death of the patients. Results Among the 18 critical patients, 12 cases were treated with vein-artery ECMO, four with vein-vein ECMO and two with vein-artery-artery ECMO. Totally seven (38.9%) cases were successfully offline and five (27.8%) cases survived. The offline rate and success rate of the patients with circulatory failure were 62.5% (5/8) and 37.5% (3/8), respectively, while those of the patients with respiratory failure were both 20% (2/10). None of the six patients with adult respiratory distress syndrome (ARDS) secondary to severe burn, trauma or operation survived. The survival rates of patients with ARDS secondary to pulmonary disease (HR=12.3, 95%CI:2.2-69.9; P<0.01) and patients with circulatory failure (HR=4.6, 95% CI:1.1-19.5; P<0.05) were significantly higher than that of patients with ARDS secondary to non-pulmonary causes, while there was no significant difference in survival rate between the patients with circulatory failure and ARDS secondary to pulmonary disease. Conclusion Prompt selection of ECMO treatment time, improvement of the treatment procedure, active treatment of primary disease, and prevention of complications are the keys of ECMO treatment. The establishment of hospital emergency channel and the formation of ECMO treatment team with multidisciplinary and multisectoral cooperation should be carried out to insure the success of ECMO treatment. |
| Key words: thoracic and cardiovascular surgery extracorporeal membrane oxygenation critical patient indication survival rate |
