体外膜肺氧合在成人大面积肺血栓栓塞中的应用
摘要
目的总结体外膜肺氧合(ECMO)在成人大面积肺血栓栓塞(massive PTE)中的救治经验,探讨ECMO的临床疗效及其应用价值。方法收集因传统治疗无效而行ECMO救治的massive PTE患者。ECMO病例均使用美国Medtionic公司Cameda肝素涂抹套装管路,选择经皮切开股动静脉插管置管,采用(V-A)ECMO模式进行辅助转流。通过比较辅助前后血流动力学、血气分析指标来评估ECMO的辅助疗效。结果共3例成人massive PTE患者行ECMO辅助,建立ECMO时间15~25 min,辅助时间(61.4±12.2)h,成功脱机2例,康复出院2例(66.7%)。辅助前后相关指标进行比较后发现:血流动力学指标(HR、MAP、CVP)、血气分析指标(p H、Pa O2、Pa CO2、Sa O2)及血乳酸含量比较差异有统计学意义(P<0.05)。结论 ECMO能迅速稳定massive PTE患者的呼吸、循环功能,可为massive PTE原发病的诊治赢得时机,是目前抢救massive PTE较为有效的方法。
引文
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[2]侯六生,谢钢,李建伟,等.体外膜肺氧合在成人心源性休克救治中的临床应用[J].中华心血管病杂志,2013,41(7):590-593.
[3]方尔斌,吴汝桐,吴丽英,等.体外膜肺氧合技术救治成人心源性休克的并发症与预后关系[J].广东医学,2014,35(11):1741-1742.
[4]王辰.肺血栓栓塞症[M]∥陆再英,钟南山.内科学.7版.北京:人民卫生出版社,2008:79-87.
[5]Silvetti S,Pappalardo F,Melisurgo G,et al.Ultrasound-accelerated thrombolysis and extracorporeal membrane oxygenation in a patient with massive pulmonary embolism and cardiac arrest[J].Circ Cardiovasc Interv,2013,6(3):34-36.
[6]Hsieh PC,Wang SS,Ko WJ,et al.Successful resuscitation of acute massive pulmonary embolism with extracorporeal membrane oxygenation andopen embolectomy[J].Ann Thorac Surg,2001,72(1):266-267.
[7]Frickey N,Kraincuk P,Zhilla I,et al.Fulminant pulmonary embolism treated by extracorporeal membrane oxygenation in a patient with traumatic brain injury[J].J Trauma,2008,64(3):E41-E43.