Baek J-K, Lee J S, Kim T H, Kim Y H, Han D J, Hong S K
Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.
Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.
Transplant Proc. 2016 Jul-Aug;48(6):2080-3. doi: 10.1016/j.transproceed.2016.04.022.
Kidney transplant (KT) recipients are vulnerable to infections because of their immunosuppressive treatments, and they occasionally exhibit serious acute cardiopulmonary dysfunction. The purpose of this study was to report the clinical outcomes of using extracorporeal membrane oxygenation (ECMO) in KT recipients and to identify risk factors for ECMO weaning failure.
We retrospectively reviewed the electronic medical records of KT patients who experienced severe cardiopulmonary dysfunction refractory to conventional therapy and received ECMO at the Asan Medical Center Surgical Intensive Care Unit between December 2010 and December 2014.
During the 4-year study period, 12 KT patients required ECMO management. Six of these patients were successfully weaned from ECMO; the mean duration of ECMO support was 9.1 days (range, 3.5-15.1 days). Indications for ECMO included pneumonia (8 cases required venovenous ECMO and 1 case required venoarterial [VA] ECMO), stress-induced cardiomyopathy due to fungemia (1 case required VA ECMO), and septic shock due to either urinary tract infection or unknown origin (2 cases required VA ECMO). In assessing risk factors leading to a failure of ECMO weaning, the pH on arterial blood gas analysis performed just before the beginning of this intervention was significantly lower in the nonsurvivors than in the survivors (P = .046).
ECMO can be a beneficial rescue therapy in immunosuppressed patients with cardiopulmonary dysfunction refractory to treatment. Severe acidosis before the administration of EMCO is a major determinant of ECMO weaning failure.
肾移植（KT）受者因免疫抑制治疗而易发生感染，且偶尔会出现严重的急性心肺功能障碍。本研究的目的是报告在KT受者中使用体外膜肺氧合（ECMO）的临床结果，并确定ECMO撤机失败的危险因素。
我们回顾性分析了2010年12月至2014年12月在峨山医学中心外科重症监护病房因常规治疗难以控制的严重心肺功能障碍而接受ECMO治疗的KT患者的电子病历。
在4年的研究期间，12例KT患者需要ECMO治疗。其中6例患者成功撤机；ECMO支持的平均持续时间为9.1天（范围为3.5 - 15.1天）。ECMO的适应证包括肺炎（8例需要静脉 - 静脉ECMO，1例需要静脉 - 动脉[VA]ECMO）、真菌血症导致的应激性心肌病（1例需要VA ECMO）以及尿路感染或不明原因引起的感染性休克（2例需要VA ECMO）。在评估导致ECMO撤机失败的危险因素时，干预开始前进行的动脉血气分析中的pH值在非存活者中显著低于存活者（P = 0.046）。
ECMO对于治疗难治性心肺功能障碍的免疫抑制患者可能是一种有益的挽救治疗方法。在使用ECMO之前的严重酸中毒是ECMO撤机失败的主要决定因素。
