摘要目的 评价体外膜氧合(ECMO)治疗重症ARDS的临床效果.方法 回顾性分析2008年1月至2011年6月无锡市人民医院重症医学科收治的达到ECMO标准的成人重症ARDS患者25例,根据ECMO使用与否分为ECMO组和非ECMO组,以应用ECMO后30 d为观察点,又将ECMO组分为ECMO生存组和ECMO病死组.比较各组治疗前后的临床特征及预后特点.以SPSS 13.0统计软件进行处理.结果 11例患者行ECMO治疗,其中男7例,女4例,年龄21 ～61岁,平均(42±12)岁.应用ECMO前机械通气时间为(12±8)h,PaO2/FiO2和PaCO2分别为(52 ± 19)mm Hg(1 mm Hg =0.133 kPa)和(84±11)mm Hg.ECMO治疗的患者中有6例存活,ECMO组与非ECMO组生存率差异无统计学意义(分别为54.5％和35.7％,x2=2.232,P＞0.05).生存组和病死组应用ECMO的时间分别为(10.4±3.4)d和(6.2±2.4)d.ECMO应用早期,生存组和病死组PaO2/FiO2明显上升(均P＜ 0.05)、PaCO2明显下降(均P＜0.05).生存组血乳酸水平和去甲肾上腺素剂量降低(均P＜0.05),病死组则相反(均P＜0.05).结论 ECMO是治疗重症ARDS的一种有效手段,常规机械通气效果不佳的ARDS患者应尽早应用.

abstractsObjective To evaluate the value of extracorporeal membrane oxygenation (ECMO) for adult patients with severe acute respiratory distress syndrome (ARDS).Methods Twenty-five adult patients with severe ARDS admitted to Intensive Care Unit of Wuxi People' s Hospital from January 2008 to June 2011 were retrospectively studied.All the cases met the ECMO criteria.Patients were divided into ECMO group and non-ECMO group according to whether they were treated with ECMO or not.ECMO group was further divided into ECMO survivor group and ECMO non-survivor group according to the situation on the 30th day after ECMO treatment.Clinical features and prognosis were compared between groups.The statistics software of SPSS 13.0 was used for data analysis.Results Of the 25 patients,11 were treated with ECMO.There were 7 males and 4 females,aged from 21 to 61 years,with a mean age of (42 ± 12) years.Mean time of mechanical ventilation before ECMO therapy was (12 ± 8) h,with PaO2/FiO2 of (52 ± 19)mm Hg (1 mm Hg =0.133 kPa) and PaCO2 (84 ± 11) mm Hg.Six patients treated with ECMO survived.The survival rate between the ECMO group and non-ECMO group was not significantly different (54.5％,35.7％,x2=2.232,P ＞0.05).Duration of ECMO therapy was (10.4 ± 3.4) d in survivors and (6.2 ± 2.4) d in non-survivors.Early improvement of PaO2 to FiO2 ratio and decrease of PaCO2 were seen in both ECMO survivor group and non-survivor group (t =2.568-22.490,all P ＜ 0.05).In survivor group,sermn lactate levels and norepinephrin doses decreased significantly (t =4.679-23.397,all P ＜ 0.05),while the serum lactate levels and norepinephrin doses increased in non-survivor group(t =4.325-29.729,all P ＜ 0.05).Conclusions Available data and our experience suggest that ECMO may be an effective salvage treatment for severe ARDS and should be used as early as possible for ARDS patients responding poorly to conventional mechanical ventilation support.