急性呼吸窘迫综合征体外膜肺氧合治疗后并发症对预后的影响

发布时间：2018-09-05 19:45

【摘要】：目的探讨急性呼吸窘迫综合征(ARDS)体外膜肺氧合(ECMO)治疗后并发症对预后的影响。方法选取33例重度ARDS患者,对其给予经口气管插管及有创机械通气、保护性肺通气、容量管理及营养支持、镇静镇痛等治疗,采用静脉-静脉(V-V)模式进行ECMO治疗,观察并发症发生情况,并分析预后。结果 ECMO辅助时间为5.9~18.6(11.67±3.22)d。33例ARDS患者中23例成功撤离ECMO,成功撤机率69.7%。26例出现至少一种以上ECMO相关并发症,发生率为78.8%。机体并发症:穿刺或切口处渗血及出血16例、消化道出血5例、感染4例、肝肾功能不全19例、脑血管意外3例、弥漫性血管内凝血(DIC)7例、MODS 8例;机械并发症:膜肺渗漏及更换14例、系统内血栓16例。进一步分析发现肾功能不全、DIC、MODS、膜肺渗漏及更换与院内死亡有关(P0.05)。结论 ECMO治疗ARDS的临床效果不甚满意,并发症发生率高,肾功能不全、DIC、MODS、膜肺渗漏及更换均影响患者预后。
[Abstract]:Objective to investigate the effect of complications on prognosis of acute respiratory distress syndrome (ARDS) after extracorporeal membrane pulmonary oxygenation (ECMO). Methods Thirty-three patients with severe ARDS were treated with orotracheal intubation and invasive mechanical ventilation, protective pulmonary ventilation, volume management and nutritional support, sedation and analgesia. ECMO was treated with V-V mode. The complications were observed and the prognosis was analyzed. Results the assistant time of ECMO was 5.9 卤18.6 (11.67 卤3.22) d.33 patients with ARDS. The probability of successful evacuation of ECMO, was 69.7.26 cases, and the incidence was 78.8%. Complications included bleeding and bleeding at puncture or incision in 16 cases, gastrointestinal bleeding in 5 cases, infection in 4 cases, liver and kidney insufficiency in 19 cases, cerebrovascular accident in 3 cases, diffuse intravascular coagulation in 7 cases and mods in 8 cases. Mechanical complications included 14 cases of membrane lung leakage and replacement and 16 cases of systemic thrombus. Further analysis found that DIC MODS, membrane lung leakage and replacement were related to hospital death (P0.05). Conclusion the clinical effect of ECMO in the treatment of ARDS is not satisfactory, the incidence of complications is high, the renal insufficiency is DIC-MODS, the membrane lung leakage and replacement all affect the prognosis of the patients.
【作者单位】：郑州大学第二附属医院;
【基金】：郑州大学第二附属医院人才基金项目
【分类号】：R563.8

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