Wang Chuan-hai, Tong Zhao-hui, Zhan Qing-yuan, Sun Bing, Quan Jing-yu, Li Cheng-hong
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Institute of Respiratory Disease, Beijing 100020, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Feb;24(2):83-5.
To investigate the therapeutic effects and safety of extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS).
ECMO were initiated in 6 patients with ARDS, not responding to conventional mechanical ventilation. Oxygenation status, positive end-expiratory pressure (PEEP) level, and fraction of inspired oxygen [FiO(2)] were compared before and after treatment with ECMO, while the adverse effects of ECMO were recorded.
In 6 cases, pulse blood oxygen saturation [SpO(2)] was elevated (0.45-0.92 up to 0.94-1.00), PEEP level [cm H(2)O, 1 cm H(2)O=0.098 kPa] and [FiO(2)] were lowered [PEEP: 10.0-22.0 down to 4.0-15.0; FiO(2): 1.00 down to 0.30-0.60] after treatment with ECMO. Of 6 cases, 2 patients with severe influenza A/H1N1 pneumonia finally died of shock; 1 patient with severe influenza A/H1N1 pneumonia and 1 patient with Klebsiella pneumoniae pneumonia were withdrawn from ECMO treatment because of deterioration of the disease. One patient suffering from Cytomegalovirus pneumonia and another with Acinetobacter baumannii pneumonia were successfully discharged from hospital with recovery. The main complications were bleeding and hemolysis.
ECMO could improve gas exchange, oxygenation and partially replace pulmonary function. Patients with ARDS should be treated with ECMO early if artificial ventilation treatment was unresponsive.
探讨体外膜肺氧合（ECMO）治疗急性呼吸窘迫综合征（ARDS）患者的疗效及安全性。
对6例ARDS患者在常规机械通气无效后启动ECMO治疗。比较ECMO治疗前后的氧合状态、呼气末正压（PEEP）水平及吸入氧分数[FiO₂]，并记录ECMO的不良反应。
6例患者经ECMO治疗后，脉搏血氧饱和度[SpO₂]升高（从0.45 - 0.92升至0.94 - 1.00），PEEP水平[cm H₂O，1 cm H₂O = 0.098 kPa]及[FiO₂]降低[PEEP：从10.0 - 22.0降至4.0 - 15.0；FiO₂：从1.00降至0.30 - 0.60]。6例中，2例甲型H1N1流感重症肺炎患者最终死于休克；1例甲型H1N1流感重症肺炎患者和1例肺炎克雷伯菌肺炎患者因病情恶化退出ECMO治疗。1例巨细胞病毒肺炎患者和另1例鲍曼不动杆菌肺炎患者康复出院。主要并发症为出血和溶血。
ECMO可改善气体交换、氧合并部分替代肺功能。ARDS患者若人工通气治疗无效应尽早行ECMO治疗。
