Wagner P K, Knoch M, Sangmeister C, Müller E, Lennartz H, Rothmund M
Department of Surgery, Philipps University Hospital, Marburg, FRG.
Br J Surg. 1990 Dec;77(12):1395-8. doi: 10.1002/bjs.1800771224.
Extracorporeal carbon dioxide removal (ECCO2-R) over a membrane lung is a new therapy for patients with adult respiratory distress syndrome (ARDS) who frequently suffer from lung complications caused by long-term artificial ventilation and who may require major thoracic surgery. This is a report of 76 patients with severe ARDS who were treated by ECCO2-R. Twenty-six of these 76 patients required thoracotomy: 19 for pneumothorax and pneumatocele, and seven for haemothorax, infected lung necrosis or oesophagotracheal fistula. Most pneumothoraces were bilateral. Ten of these 26 patients required reoperation, usually for extensive persisting alveolar air leaks. Sixteen (62 per cent) of the 26 patients who had a thoracotomy and 22 (44 per cent) of the 50 patients without surgery survived. These results demonstrate that performing a thoracotomy, if necessary, does not diminish the survival chance of high-risk patients with severe ARDS.
通过膜肺进行体外二氧化碳清除（ECCO2-R）是治疗成人呼吸窘迫综合征（ARDS）患者的一种新疗法，这类患者常因长期人工通气而出现肺部并发症，且可能需要进行大型胸外科手术。本文报告了76例接受ECCO2-R治疗的重度ARDS患者。这76例患者中有26例需要开胸手术：19例因气胸和肺气囊，7例因血胸、感染性肺坏死或食管气管瘘。多数气胸为双侧性。这26例患者中有10例需要再次手术，通常是因为存在广泛持续的肺泡漏气。接受开胸手术的26例患者中有16例（62%）存活，未接受手术的50例患者中有22例（44%）存活。这些结果表明，必要时进行开胸手术并不会降低重度ARDS高危患者的存活几率。
