Yamada Taihei, Osako Takaaki, Sakata Hiroyuki, Kuboyama Kazutoshi, Matsuda Keinichi, Okamoto Ayana, Nakao Atsunori, Kotani Joji
Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.
Acute Med Surg. 2013 Dec 4;1(2):105-108. doi: 10.1002/ams2.11. eCollection 2014 Apr.
We report a patient with life-threatening lung contusion who was rescued using poly-2-methoxyethyl acrylate, a biocompatible polymer surface coating for extracorporeal membrane oxygenation, which enabled reduction of the dose of systemic anticoagulation to prevent circuit thrombosis.
A 56-year-old man was transferred to our hospital due to blunt chest trauma following a 30-m fall into water. Chest X-ray and computed tomography showed bilateral lung contusions with bilateral pneumothorax. Although drainage tubes were inserted and ventilation with positive-airway pressure was applied, PaO /FiO remained <80 mmHg. Extracorporeal membrane oxygenation was started with heparin (5,000 units) to prevent circuit thrombosis on day 1. No significant bleeding complications or clot formation in the extracorporeal circuit were observed, with stable activated clotting time of 100-160 s without further anticoagulants.
Our case showed that poly-2-methoxyethyl acrylate-coated extracorporeal membrane oxygenation can be safely applied to patients with lung contusion associated with chest trauma.
我们报告了一名患有危及生命的肺挫伤的患者,其使用聚-2-甲氧基乙基丙烯酸酯(一种用于体外膜肺氧合的生物相容性聚合物表面涂层)进行了抢救,这使得能够减少全身抗凝剂量以预防体外循环血栓形成。
一名56岁男性因从30米高处坠入水中后胸部钝性创伤被转至我院。胸部X线和计算机断层扫描显示双侧肺挫伤合并双侧气胸。尽管插入了引流管并应用了气道正压通气,但动脉血氧分压/吸入氧分数值(PaO₂/FiO₂)仍低于80 mmHg。在第1天开始使用肝素(5000单位)进行体外膜肺氧合以预防体外循环血栓形成。未观察到明显的出血并发症或体外循环中的血栓形成,活化凝血时间稳定在100 - 160秒,无需进一步抗凝。
我们的病例表明,聚-2-甲氧基乙基丙烯酸酯涂层的体外膜肺氧合可安全应用于与胸部创伤相关的肺挫伤患者。