摘要目的 探讨静脉-静脉体外膜肺氧合(VV-ECMO)治疗重症急性呼吸窘迫综合征(ARDS)患者的临床疗效,并对其相关因素进行分析.方法 采用回顾性分析方法,共纳入22例重度ARDS患者,其中ECMO组为采用ECMO技术治疗的8例重症ARDS患者,均采用VV-ECMO方式,收集资料包括患者一般资料,ECMO运行前后血气分析、血流动力学、机械通气参数以及ECMO辅助并发症等.对照组为未开展ECMO技术以前治疗的14例重症ARDS患者,同样采集患者一般资料,治疗期间的血气分析、血流动力学以及机械通气参数等数据.结果 在该研究中,共有8例重症ARDS接受ECMO治疗,男性5例,女性3例,平均年龄(46.3±14.1)岁.与对照组相应时间比较,在应用ECMO治疗后24h,ECMO组各项指标除平均动脉压(t=-0.872,P=0.357)之外:呼吸频率(t=-1.670,P=0.034)、心率(t=-1.973,P=0.042)、pH(t=-1.432,P=0.033)、二氧化碳分压(t=-2.564,P=0.024)、氧分压(t=-4.955,P＜0.001)、氧合指数(t=-3.654,P＜0.01)、PEEP(t=-1.382,P=0.031)、Pplateau(t=-2.785,P＜0.01)、血乳酸(t=-2.564,P=0.024)均显著改善.另外两组间比较在入住ICU时间(t=-2.452,P=0.027)、总机械通气时间(t=-1.478,P=0.038)、器官功能衰竭数目(t=-1.963,P=0.047)、住院病死率(t=-1.970,P=0.045)以及住院费用(t=-1.667,P=0.035)方面差异也有统计学意义.同时,将ECMO组分为存活组与死亡组,在ECMO治疗前机械通气事件(P =0.031)、总机械通气时间(P=0.038)、ECMO辅助时间(P =0.047)、住ICU时间(P=0.043)、住院费用(P =0.037)等方面差异也有统计学意义.结论 对于重症ARDS患者,ECMO可显著改善其氧合与通气等呼吸生理指标,并为肺脏休息及治疗修复赢得时间;但年龄、ECMO治疗前机械通气时间以及导致ARDS的原发病因是影响ARDS患者预后的重要影响因素.

abstractsObjective To investigate the clinical experience and associated factors of extracorporeal membrane oxygenation(ECMO)for adult patients with severe acute respiratory distress syndrome(ARDS).Methods The clinical data of 22 adult patients with severe ARDS,which met the criteria for ECMO,were retrospectively collected and analyzed.The ECMO team all receiving VV-ECMO treatment (Veno-venous extracorporeal membrane oxygenation),data collection including the patients,general data,blood gas analysis,hemodynamics,mechanical ventilation parameter before and after the ECMO treatment and the auxiliary complications,etc.The control group were 14 cases of patients with severe ARDS which receiving conventional treatment;We collected the same data as the research team.Results In the research,8 patients treated with VV-ECMO,There were 5 males and 3 females,with an average age of (46.3 ± 14.1)years.Compared with the factors at the same time point in the control group,those of the ECMO group,except MAP (t =-0.872,P =0.357),Respiratory rate (t =-1.670,P =0.357),Heart rate (t =-1.973,P =0.042),PH (t =-1.432,P =0.033),PaCO2 (t =-2.564,P =0.024),PO2 (t =-4.955,P ＜ 0.001),PO2/FiO2 (t =-3.654,P ＜ 0.01),PEEP (t =-1.382,P =0.031),Pplateau (t =-2.785,P ＜ 0.01),Blood lactate (t =-2.564,P =0.024) were significantly improved after ECMO running 24 hours (all P ＜ 0.05).And also the factors such as the length of ICU stay (t =-2.452,P =0.027),the times of mechanical ventilation (t =-1.478,P =0.038),number of organ failure(t =-1.963,P =0.047),the hospital mortality rates(t =-1.970,P =0.045) and treatment costs(t =-1.667,P =0.035) between the ECMO group and the control group were significantly different (P ＜0.05).In the end,we divided the ECMO group into survival group and death group,and compare the time of Mechanical Ventilation before ECMO(P =0.031) the total time of Mechanical Ventilation(P =0.038),the time of ECMO adjutant (P =0.047),the length of ICU stay (P =0.043) and the cost of treatment (P =0.037) between the two groups;and there were also statistically significant difference (P ＜ 0.05).Conclusion ECMO can significantly improve the patients,oxygenation and respiratory physiology indexes which can not sustain under the conventional mechanical ventilation therapy and win the time for rest and repair of lung.Indexes such as age,time of mechanical ventilation before ECMO therapy,the primary cause of ARDS are the important factors influencing the efficacy of ECMO treatment in the patients with severe ARDS.