ECMO治疗甲型H1N1流感病毒感染致ARDS的临床研究
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摘要
目的探讨体外循环膜人工氧合法(Extracorporeal membrane oxygenation,ECMO)治疗甲型H1N1流感病毒感染导致急性呼吸窘迫综合征(ARDS)的临床疗效。方法选择2009年5月-2018年2月于医院接受ECMO治疗的甲型H1N1流感病毒感染致ARDS患者28例为研究对象。比较ECMO支持治疗前6h、ECMO治疗后2h及24h的生命体征及血流动力学指标、呼吸力学指标[心率、平均压、pH值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、氧合指数(FiO_2)]。统计ECMO治疗期间及撤离后患者的并发症情况及临床转归。比较ECMO治疗前后机械通气参数设置情况。根据患者是否存活出院分为存活组16例和死亡组12例,比较两组患者的ECMO相关指标。结果 ECMO治疗后患者的心率、PaCO_2、FiO_2低于治疗前6h,平均压、pH值、PaO_2高于治疗前(P<0.001)。ECMO治疗后的呼吸道峰压、呼气末正压通气(PEEP)均低于治疗前,呼吸频率高于治疗前6h(P<0.001)。28例患者接受ECMO治疗后,21例患者成功脱离ECMO,其中16例存活出院,存活率57.14%。存活组患者年龄,ECMO前有创正压通气时间,ECMO距发病时间分别为(30.53±3.12)岁,(22.51±2.62)h,(11.23±1.03)h,与死亡组比较差异有统计学意义(P<0.05)。结论 ECMO作为体外生命支持的一种手段,可满足甲型H1N1流感合并ARDS时的气体交换需要,能改善患者的氧合与通气状况。
OBJECTIVE To explore the effect of extracorporeal membrane oxygenation in treatment of the adult respiratory distress syndrome associated with influenza A(H1 N1)infection.METHODS 28 patients with respiratory distress syndrome associated with influenza A(H1 N1)infection who received ECMO treatment in the hospital during May 2009 to Feb.2018 were enrolled in the study.The life signs,hemodynamic indexes and respiratory mechanics indexes including heart rate,mean pressure,pH value,arterial partial pressure of oxygen(PaO_2),arterial partial pressure of carbon dioxide(PaCO_2),and oxygenation index(FiO_2)were compared 6 hbefore the ECMO treatment and 2 hand 24 hafter the ECMO treatment.The complications and clinical outcomes of patients during and after the ECMO treatment were analyzed.The mechanical ventilation parameters before and after ECMO treatment were compared.The ECMO-related indicators were compared between the two groups of patients according to whether the patients survived,with 16 cases in the survival group and 12 cases in the death group.RESULTS After ECMO treatment,the heart rate,PaCO_2 and FiO_2 and the average pressure were significantly lower than those before treatment,PH value and PaO_2 were significantly higher than those before treatment(P<0.001).After the ECMO treatment,the respiratory peak pressure and positive expiratory pressure ventilation(PEEP)were significantly lower than those before treatment,and the respiratory rate was significantly higher than that before treatment(P<0.001).Of the 28 patients who received ECMO treatment,21 patients successfully weaned from ECMO,16 of them survived and were discharged from the hospiatl,with a survival rate of57.14%.The age,time of invasive positive pressure ventilation before ECMO,the time between the onset time and ECMO treament,cases with complications before ECMO,and organ failure rate after ECMO of the patients in the survival group were respectively(30.53±3.12)years old,(22.51±2.62)h,(11.23±1.03)h,the differences were significant(P<0.05).CONCLUSION As a means of life support in vitro,CMO can support the gas change required by the patients with influenza A(H1 N1)combined with ARDS,and improve the oxygenation and ventilation status of the patients.
OBJECTIVE To explore the effect of extracorporeal membrane oxygenation in treatment of the adult respiratory distress syndrome associated with influenza A(H1 N1)infection.METHODS 28 patients with respiratory distress syndrome associated with influenza A(H1 N1)infection who received ECMO treatment in the hospital during May 2009 to Feb.2018 were enrolled in the study.The life signs,hemodynamic indexes and respiratory mechanics indexes including heart rate,mean pressure,pH value,arterial partial pressure of oxygen(PaO_2),arterial partial pressure of carbon dioxide(PaCO_2),and oxygenation index(FiO_2)were compared 6 hbefore the ECMO treatment and 2 hand 24 hafter the ECMO treatment.The complications and clinical outcomes of patients during and after the ECMO treatment were analyzed.The mechanical ventilation parameters before and after ECMO treatment were compared.The ECMO-related indicators were compared between the two groups of patients according to whether the patients survived,with 16 cases in the survival group and 12 cases in the death group.RESULTS After ECMO treatment,the heart rate,PaCO_2 and FiO_2 and the average pressure were significantly lower than those before treatment,PH value and PaO_2 were significantly higher than those before treatment(P<0.001).After the ECMO treatment,the respiratory peak pressure and positive expiratory pressure ventilation(PEEP)were significantly lower than those before treatment,and the respiratory rate was significantly higher than that before treatment(P<0.001).Of the 28 patients who received ECMO treatment,21 patients successfully weaned from ECMO,16 of them survived and were discharged from the hospiatl,with a survival rate of57.14%.The age,time of invasive positive pressure ventilation before ECMO,the time between the onset time and ECMO treament,cases with complications before ECMO,and organ failure rate after ECMO of the patients in the survival group were respectively(30.53±3.12)years old,(22.51±2.62)h,(11.23±1.03)h,the differences were significant(P<0.05).CONCLUSION As a means of life support in vitro,CMO can support the gas change required by the patients with influenza A(H1 N1)combined with ARDS,and improve the oxygenation and ventilation status of the patients.
引文
[1] Ma Q,Yu Q,Xing X,et al.San Wu Huangqin decoction,a Chinese herbal formula, inhibits influenza a/PR/8/34(H1N1)virus infection in vitro and in vivo[J].Viruses,2018,10(3):E117.
[2] Broman LM.Inter-hospital transports on extracorporeal membrane oxygenation in different health-care systems[J].J Thorac Dis,2017,9(9):3425-3429.
[3] Rawal G,Kumar R,Yadav S,et al.H1N1influenza induced acute respiratory distress syndrome rescued by extracorporeal membrane oxygenation:a case report[J].J Transl Int Med,2017,5(3):182-185.
[4]钟南山,李兰娟,王辰,等.甲型H1N1流感治疗方案(2009年第3版)[J].中华医学杂志,2009,89(45):559.
[5] Menon N,Perez-Velez CM,Wheeler JA,et al.Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A(H1N1)pdm09pneumonia.A single-center experience during the 2013-2014season[J].Rev Bras Ter Intensiva,2017,29(3):271-278.
[6] Jansen O,Kamp O,Waydhas C,et al.Extracorporeal membrane oxygenation in spina bifida and(H1N1)-induced acute respiratory distress syndrome[J].J Artif Organs,2017,20(4):354-358.
[7] Hemmila MR,Rowe SA,Boules TN,et al.Extracorporeal life support for severe acute respiratory distress syndrome in adults[J].Ann Surg,2004,240(4):595-605.
[8] Conrad SA,Rycus PT,Dalton H.Extracorporeal life support registry report 2004[J].ASAIO J,2005,51(1):4-10.
[9] Australia and New Zealand Extracorporeal Membrane Oxygenation(ANZ ECMO)Influenza Investigators1,Davies A,Jones D,et al.Extracorporeal membrane oxygenation for2009influenza A(H1N1)acute respiratory distress syndrome[J].JAMA,2009,302(17):1888-1895.
[10] Liang T,Lee KL,Poon YS,et al.The first novel influenza A(H1N1)fatality despite antiviral treatment and extracorporeal membrane oxygenation in Hong Kong[J].Hong Kong Med J,2009,15(5):381-384.
[11] Tillmann BW,Klingel ML,Iansavichene AE,et al.Extracorporeal membrane oxygenation(ECMO)as a treatment strategy for severe acute respiratory distress syndrome(ARDS)in the low tidal volume era:a systematic review[J].J Crit Care,2017,41:64-71.
[12]许碧芳,李娜,林秀霞.体外膜肺氧合联合连续肾脏替代疗法在重症患者中的应用与护理[J].中华现代护理杂志,2013,19(6):698-700.
[13]庄文君,钱春艳.CRRT联合ECMO对抗感染治疗影响的探讨[J].中西医结合心血管病电子杂志,2018,6(28):29.
[14]侯雅琴,封永莉,张晓勤,等.体外膜肺氧合对成人抗感染药物药动学的影响[J].实用药物与临床,2018,21(09):965-969.
[2] Broman LM.Inter-hospital transports on extracorporeal membrane oxygenation in different health-care systems[J].J Thorac Dis,2017,9(9):3425-3429.
[3] Rawal G,Kumar R,Yadav S,et al.H1N1influenza induced acute respiratory distress syndrome rescued by extracorporeal membrane oxygenation:a case report[J].J Transl Int Med,2017,5(3):182-185.
[4]钟南山,李兰娟,王辰,等.甲型H1N1流感治疗方案(2009年第3版)[J].中华医学杂志,2009,89(45):559.
[5] Menon N,Perez-Velez CM,Wheeler JA,et al.Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A(H1N1)pdm09pneumonia.A single-center experience during the 2013-2014season[J].Rev Bras Ter Intensiva,2017,29(3):271-278.
[6] Jansen O,Kamp O,Waydhas C,et al.Extracorporeal membrane oxygenation in spina bifida and(H1N1)-induced acute respiratory distress syndrome[J].J Artif Organs,2017,20(4):354-358.
[7] Hemmila MR,Rowe SA,Boules TN,et al.Extracorporeal life support for severe acute respiratory distress syndrome in adults[J].Ann Surg,2004,240(4):595-605.
[8] Conrad SA,Rycus PT,Dalton H.Extracorporeal life support registry report 2004[J].ASAIO J,2005,51(1):4-10.
[9] Australia and New Zealand Extracorporeal Membrane Oxygenation(ANZ ECMO)Influenza Investigators1,Davies A,Jones D,et al.Extracorporeal membrane oxygenation for2009influenza A(H1N1)acute respiratory distress syndrome[J].JAMA,2009,302(17):1888-1895.
[10] Liang T,Lee KL,Poon YS,et al.The first novel influenza A(H1N1)fatality despite antiviral treatment and extracorporeal membrane oxygenation in Hong Kong[J].Hong Kong Med J,2009,15(5):381-384.
[11] Tillmann BW,Klingel ML,Iansavichene AE,et al.Extracorporeal membrane oxygenation(ECMO)as a treatment strategy for severe acute respiratory distress syndrome(ARDS)in the low tidal volume era:a systematic review[J].J Crit Care,2017,41:64-71.
[12]许碧芳,李娜,林秀霞.体外膜肺氧合联合连续肾脏替代疗法在重症患者中的应用与护理[J].中华现代护理杂志,2013,19(6):698-700.
[13]庄文君,钱春艳.CRRT联合ECMO对抗感染治疗影响的探讨[J].中西医结合心血管病电子杂志,2018,6(28):29.
[14]侯雅琴,封永莉,张晓勤,等.体外膜肺氧合对成人抗感染药物药动学的影响[J].实用药物与临床,2018,21(09):965-969.