Hohenforst-Schmidt Wolfgang, Petermann Arndt, Visouli Aikaterini, Zarogoulidis Paul, Darwiche Kaid, Kougioumtzi Ioanna, Tsakiridis Kosmas, Machairiotis Nikolaos, Ketteler Markus, Zarogoulidis Konstantinos, Brachmann Johannes
II Medical Clinic, Coburg Clinic, University of Wuerzburg, Coburg, Germany.
Drug Des Devel Ther. 2013 Jul 24;7:627-33. doi: 10.2147/DDDT.S47156. Print 2013.
Extracorporeal membrane oxygenation (ECMO) is increasingly applied in adults with acute refractory respiratory failure that is deemed reversible. Bleeding is the most frequent complication during ECMO support. Severe pre-existing bleeding has been considered a contraindication to ECMO application. Nevertheless, there are cases of successful ECMO application in patients with multiple trauma and hemorrhagic shock or head trauma and intracranial hemorrhage. ECMO has proved to be life-saving in several cases of life-threatening respiratory failure associated with pulmonary hemorrhage of various causes, including granulomatosis with polyangiitis (Wegener's disease). We successfully applied ECMO in a 65-year-old woman with acute life-threatening respiratory failure due to diffuse massive pulmonary hemorrhage secondary to granulomatosis with polyangiitis, manifested as severe pulmonary-renal syndrome. ECMO sustained life and allowed disease control, together with plasmapheresis, cyclophosphamide, corticoids, and renal replacement therapy. The patient was successfully weaned from ECMO, extubated, and discharged home. She remains alive on dialysis at 17 months follow-up.
体外膜肺氧合（ECMO）越来越多地应用于被认为可逆的成人急性难治性呼吸衰竭患者。出血是ECMO支持期间最常见的并发症。严重的既往出血一直被视为ECMO应用的禁忌症。然而，在多发伤和失血性休克或头部外伤和颅内出血的患者中，也有成功应用ECMO的病例。在几例由各种原因引起的危及生命的呼吸衰竭合并肺出血（包括肉芽肿性多血管炎（韦格纳氏病））的病例中，ECMO已被证明能挽救生命。我们成功地为一名65岁女性应用了ECMO，该患者因肉芽肿性多血管炎继发弥漫性大量肺出血而出现急性危及生命的呼吸衰竭，表现为严重的肺肾综合征。ECMO维持了患者的生命，并与血浆置换、环磷酰胺、皮质类固醇和肾脏替代治疗一起使疾病得到控制。患者成功脱离ECMO，拔管并出院回家。在17个月的随访中，她在透析治疗下仍然存活。
