Duru J A, Menges T, Bodner J, Degen M E, Greifenberg D, Gehron J, Weigand M A, Henrich M
Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Justus-Liebig-Universität, Universitätsklinikum Gießen und Marburg, Standort Gießen, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland.
Anaesthesist. 2014 May;63(5):401-5. doi: 10.1007/s00101-014-2308-9. Epub 2014 Mar 2.
This article presents the case of a 62-year-old patient with cancer in the left upper pulmonary lobe who underwent lobe resection with postoperative respiratory insufficiency. The right upper lobe had already been resected 5 years earlier because of an adenocarcinoma. Prior to the present surgery a computed tomography scan detected a narrow stenosis at the former resection site; however, both pulmonary lobes beyond this stenosis appeared to be sufficiently ventilated. After resection of the left upper lobe attempted extubation was unsuccessful due to insufficient global gas exchange as the stenosis prevented ventilation of the right lung. Bronchoscopy provided evidence of a normal diameter of the bronchus behind the stenosis so both lobes were to be recruited after possible correction of this section. A veno-venous extracorporeal membrane oxygenation device (ECMO) was established as bridging therapy to attain normal gas exchange. As the patient showed no muscle weakness and was cooperative, extubation was performed and spontaneous breathing occurred without any support while still under ECMO treatment. The stenosis was reduced by bronchoscopic laser resection within seven consecutive sessions. Each of these surgeries was conducted with the patient under general anesthesia with oral intubation and jet ventilation in combination with the ECMO. The patient was extubated after each treatment session and weaned from ECMO after the final resection within 2 days. This case demonstrates the use of ECMO in combination with surgical procedures in a spontaneously breathing patient as a causal therapy and option for selected patients to prevent complications from long-term ventilation.
本文介绍了一名62岁左上肺叶癌症患者的病例，该患者接受了肺叶切除术后出现呼吸功能不全。5年前，其右上肺叶因腺癌已被切除。在本次手术前，计算机断层扫描在先前的切除部位检测到一处狭窄；然而，该狭窄部位以外的两个肺叶似乎通气良好。切除左上肺叶后，由于整体气体交换不足，拔管未成功，因为狭窄阻碍了右肺通气。支气管镜检查显示狭窄部位后方支气管直径正常，因此在可能纠正该部位后，两个肺叶都要进行通气。建立了静脉-静脉体外膜肺氧合装置（ECMO）作为过渡治疗以实现正常气体交换。由于患者没有肌肉无力且配合良好，在仍接受ECMO治疗的情况下进行了拔管，患者在没有任何支持的情况下自主呼吸。通过连续七次支气管镜激光切除术减轻了狭窄。每次手术均在患者全身麻醉、经口插管和喷射通气并联合ECMO的情况下进行。每次治疗后患者均进行拔管，并在最后一次切除术后2天内脱离ECMO。该病例证明了在自主呼吸的患者中将ECMO与手术相结合作为一种病因治疗方法，以及为选定患者预防长期通气并发症的一种选择。
