Ng George W Y, Leung Anne K H, Sin K C, Au S Y, Chan Stanley C H, Chan Osburga P K, Wu Helen H L
Department of Intensive Care, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
Hong Kong Med J. 2014 Oct;20(5):407-12. doi: 10.12809/hkmj144211. Epub 2014 Jun 20.
To present the 3-year experience of using venovenous extracorporeal membrane oxygenation for patients with severe respiratory failure in a single centre in Hong Kong.
Case series.
A 19-bed Intensive Care Unit of a tertiary hospital in Hong Kong.
All patients who were managed with venovenous extracorporeal membrane oxygenation from 1 July 2010 to 30 June 2013 in the Intensive Care Unit.
Overall, 31 patients (mean age, 42.2 years, standard deviation, 14.1 years; 21 males) received venovenous extracorporeal membrane oxygenation for the treatment of severe respiratory failure. Of these, 90.3% (28 patients) presented with pneumonia as the cause of the respiratory failure, and 22 of them had identifiable causes. A total of nine (29.0%) patients were diagnosed to have H1N1 infection. The median Murray score was 3.5 (interquartile range, 3.0-3.5); the median duration of venovenous extracorporeal membrane oxygenation support was 5.0 (2.8-8.6) days; and the median duration of mechanical ventilator support was 18.2 (7.8-27.9) days. The overall intensive care unit mortality was 19.4% (n=6). The overall in-hospital mortality and the 28-day mortality were both 22.6% (n=7). Among the 22 patients who had identifiable infective causes, those suffering from viral infection had lower intensive care unit and hospital mortality than those who had bacterial infection (8.3% vs 20.0%). All the H1N1 patients survived. Complications related to extracorporeal membrane oxygenation included severe bleeding (n=2; 6.5%) and mechanical complications of the circuits (n=3; 9.7%).
Venovenous extracorporeal membrane oxygenation is an effective adjunctive therapy and can be used as a life-saving procedure for carefully selected patients with severe acute respiratory distress syndrome when the limits of standard therapy have been reached.
介绍香港某单一中心对严重呼吸衰竭患者使用静脉-静脉体外膜肺氧合（VV-ECMO）的3年经验。
病例系列。
香港一家三级医院的一间设有19张床位的重症监护病房。
2010年7月1日至2013年6月30日期间在该重症监护病房接受静脉-静脉体外膜肺氧合治疗的所有患者。
总体而言，31例患者（平均年龄42.2岁，标准差14.1岁；男性21例）接受静脉-静脉体外膜肺氧合治疗严重呼吸衰竭。其中，90.3%（28例）患者因肺炎导致呼吸衰竭，其中22例有明确病因。共有9例（29.0%）患者被诊断为H1N1感染。Murray评分中位数为3.5（四分位间距，3.0 - 3.5）；静脉-静脉体外膜肺氧合支持的中位数持续时间为5.0（2.8 - 8.6）天；机械通气支持的中位数持续时间为18.2（7.8 - 27.9）天。重症监护病房总体死亡率为19.4%（n = 6）。总体住院死亡率和28天死亡率均为22.6%（n = 7）。在22例有明确感染病因的患者中，病毒感染患者的重症监护病房和医院死亡率低于细菌感染患者（8.3%对20.0%）。所有H1N1患者均存活。与体外膜肺氧合相关的并发症包括严重出血（n = 2；6.5%）和回路机械并发症（n = 3；9.7%）。
静脉-静脉体外膜肺氧合是一种有效的辅助治疗方法，当标准治疗达到极限时，可作为精心挑选的严重急性呼吸窘迫综合征患者的救命措施。
