急性呼吸窘迫綜合征體外膜肺氧合治療后并發(fā)癥對預(yù)后的影響
發(fā)布時(shí)間：2018-09-05 19:45
【摘要】：目的探討急性呼吸窘迫綜合征(ARDS)體外膜肺氧合(ECMO)治療后并發(fā)癥對預(yù)后的影響。方法選取33例重度ARDS患者,對其給予經(jīng)口氣管插管及有創(chuàng)機(jī)械通氣、保護(hù)性肺通氣、容量管理及營養(yǎng)支持、鎮(zhèn)靜鎮(zhèn)痛等治療,采用靜脈-靜脈(V-V)模式進(jìn)行ECMO治療,觀察并發(fā)癥發(fā)生情況,并分析預(yù)后。結(jié)果 ECMO輔助時(shí)間為5.9~18.6(11.67±3.22)d。33例ARDS患者中23例成功撤離ECMO,成功撤機(jī)率69.7%。26例出現(xiàn)至少一種以上ECMO相關(guān)并發(fā)癥,發(fā)生率為78.8%。機(jī)體并發(fā)癥:穿刺或切口處滲血及出血16例、消化道出血5例、感染4例、肝腎功能不全19例、腦血管意外3例、彌漫性血管內(nèi)凝血(DIC)7例、MODS 8例;機(jī)械并發(fā)癥:膜肺滲漏及更換14例、系統(tǒng)內(nèi)血栓16例。進(jìn)一步分析發(fā)現(xiàn)腎功能不全、DIC、MODS、膜肺滲漏及更換與院內(nèi)死亡有關(guān)(P0.05)。結(jié)論 ECMO治療ARDS的臨床效果不甚滿意,并發(fā)癥發(fā)生率高,腎功能不全、DIC、MODS、膜肺滲漏及更換均影響患者預(yù)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 鹵18.6 (11.67 鹵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.
【作者單位】： 鄭州大學(xué)第二附屬醫(yī)院;
【基金】：鄭州大學(xué)第二附屬醫(yī)院人才基金項(xiàng)目
【分類號】：R563.8
[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 鹵18.6 (11.67 鹵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.
【作者單位】： 鄭州大學(xué)第二附屬醫(yī)院;
【基金】：鄭州大學(xué)第二附屬醫(yī)院人才基金項(xiàng)目
【分類號】：R563.8
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