体外膜肺氧合对重症患者的治疗效果评价

摘要:目的　评估体外膜肺氧合对重症患者的治疗效果，为今后临床救治重症ARDS患者提供依据。方法　选择2008年1月-2013年3月至我院ICU救治的患者中，由于呼吸窘迫综合症机械通气效果不佳进行ECMO支持治疗的重症患者21例作为研究对象。所有患者均采用静脉-静脉（V-V）体外膜肺流转模式，同时采用保护性肺通气策略，监测中心静脉压。评估治疗前后患者血气指标、APACHEⅡ评分、SOFA评分及患者的转归。结果　治疗前患者平均SaO2为0.81±0.03、PaCO2为47.3±6.9，pH值为7.10±0.14，经ECMO治疗后的三项指标分别为0.98±0.02、33.5±4.6及7.42±0.08，与治疗前相比差异均具有统计学意义（P＜0.001）；治疗前患者APACHEⅡ评分为17.1±7.3，SOFA评分为7.5±2.2，经过ECMO治疗后APACHEⅡ评分为6.8±3.0、SOFA评分为6.0±1.8，治疗前后相比差异具有统计学意义（P＜0.05）。在21例接受治疗的患者中，2例死亡，其余19例均顺利出院，死亡率为9.52%。结论　ECMO能减轻重症患者心肺负荷，改善患者缺氧症状，促进心肺的恢复，减少有关并发症的发生。

Assessment of extracorporeal membrane oxygenation treatment for critical patients

Abstract: Objective To evaluate extracorporeal membrane oxygenation treatment for critical patients, so as to provide a basis for the clinical treatment for severe ARDS patients. Methods 21 patients with the poor effect of mechanical ventilation for the ECMO supportie treatment on respiratory distress syndrome were collected. All of the patients took venous - vein (V - V) extracorporeal membrane oxygenation circulation pattern, while adopting protective lung ventilation strategy and monitoring the central venous pressure. We assessed the patient's blood gas index, APACHE score, SOFA score and patient outcome before and after the treatment. Results Before the treatment, SaO2 was 0.81±0.03; PaCO2 was 47.3±6.9; pH was 7.10±0.14. After ECMO treatment, the three indicators were 0.98±0.02, 33.5±4.6 and 4.6±33.5, respectively. There were statistically significant differences compared with before treatment (P<0.001). Before treatment, APACHE Ⅱ score is 17.1±7.3, and SOFA score is 7.5±2.2. After ECMO treatment, APACHE score was 6.8±3.0 and SOFA score was 6.0±1.8. There were statistically significant differences compared with before treatment (P<0.05). Among 21 cases who received treatment, 2 cases died, and the rest 19 cases were successfully discharged from the hospital, and therefore the mortality was 9.52%.