体外膜肺氧合在慢性血栓栓塞性肺动脉高压患者血栓内膜剥脱术围术期的应用
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摘要
目的探讨体外膜肺氧合(ECMO)在慢性血栓栓塞性肺动脉高压(CTEPH)患者血栓内膜剥脱术(PTE)围术期的应用。方法回顾性分析2016年1月至2017年10月于南京大学医学院附属鼓楼医院因PTE术后即出现严重并发症而应用ECMO辅助治疗的患者,均采用静脉-动脉ECMO模式进行辅助。回顾患者临床资料,分析ECMO辅助方式选择,上机指征、过程和辅助效果,以及辅助期间相关并发症等。结果患者均成功拔除气管插管,顺利撤除ECMO辅助,全部存活,康复出院。结论对PTE术后伴有严重并发症的危重症患者,应用静脉-动脉ECMO可以有针对性地缓解并发症,具有非常规治疗可比拟的临床价值。
Objective To determine the extracorporeal membrane oxygenation(ECMO) application during perioperative period of pulmonary thromboendarterectomy(PTE) in patients with chronic thromboembolic pulmonary hypertension(CTEPH). Methods We retrospectively analyzed the data of patients who received venoarterial ECMO after PTE due to serious postoperative complications in Nanjing Drum Tower Hospital from January 2016 to October 2017. The clinical features, basic characteristic, application reason, duration of ECMO and complications were descripted. Results All patients successfully weaned from mechanical ventilation and ECMO, and survived to discharge. Conclusion For critically patients with serious complications after PTE, venoarterial ECMO can be used as an efficient and effective strategy.
Objective To determine the extracorporeal membrane oxygenation(ECMO) application during perioperative period of pulmonary thromboendarterectomy(PTE) in patients with chronic thromboembolic pulmonary hypertension(CTEPH). Methods We retrospectively analyzed the data of patients who received venoarterial ECMO after PTE due to serious postoperative complications in Nanjing Drum Tower Hospital from January 2016 to October 2017. The clinical features, basic characteristic, application reason, duration of ECMO and complications were descripted. Results All patients successfully weaned from mechanical ventilation and ECMO, and survived to discharge. Conclusion For critically patients with serious complications after PTE, venoarterial ECMO can be used as an efficient and effective strategy.
引文
1 Robbins IM,Pugh ME,Hemnes AR.Update on chronic thromboembolic pulmonary hypertension[J].Trends Cardiovasc Med,2017,27(1):29-37.
2 Kim NH,Delcroix M,Jenkins DP,et al.Chronic thromboembolic pulmonary hypertension[J].J Am Coll Cardiol,2013,62(25 suppl):92-99.
3 Berman M,Tsui S,Vuylsteke A,et al.Successful extracorporeal membrane oxygenation support after pulmonary thromboendarterectomy[J].Ann Thorac Surg,2008,86(4):1261-1267.
4 Chacón-Alves S,Pérez-Vela JL,Grau-Carmona T,et al.Venoarterial ECMO for rescue of severe airway hemorrhage with rigid bronchoscopy after pulmonary artery thromboendarterectomy[J].Int J Artif Organs,2016,39(5):242-244.
5 Edemskiy A,Chernyavskiy M,Tarkova A,et al.Central extracorporeal membrane oxygenation for treatment of reperfusion oedema following pulmonary thromboendarterectomy:a case report[J].J Cardiothorac Surg,2016,11(1):76.
6 关明,邢家林,杨晓芳,等.体外膜肺氧合在肺动脉血栓内膜剥脱术围术期的应用[J].中国体外循环杂志,2014,12(2):89-109.
2 Kim NH,Delcroix M,Jenkins DP,et al.Chronic thromboembolic pulmonary hypertension[J].J Am Coll Cardiol,2013,62(25 suppl):92-99.
3 Berman M,Tsui S,Vuylsteke A,et al.Successful extracorporeal membrane oxygenation support after pulmonary thromboendarterectomy[J].Ann Thorac Surg,2008,86(4):1261-1267.
4 Chacón-Alves S,Pérez-Vela JL,Grau-Carmona T,et al.Venoarterial ECMO for rescue of severe airway hemorrhage with rigid bronchoscopy after pulmonary artery thromboendarterectomy[J].Int J Artif Organs,2016,39(5):242-244.
5 Edemskiy A,Chernyavskiy M,Tarkova A,et al.Central extracorporeal membrane oxygenation for treatment of reperfusion oedema following pulmonary thromboendarterectomy:a case report[J].J Cardiothorac Surg,2016,11(1):76.
6 关明,邢家林,杨晓芳,等.体外膜肺氧合在肺动脉血栓内膜剥脱术围术期的应用[J].中国体外循环杂志,2014,12(2):89-109.