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转换为静脉 - 动脉 - 静脉外体膜氧化对于差异性缺氧
Ho Jeong Cha1, Jong Woo Kim1, Dong Hoon Kang1
1Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea.
Journal of chest surgery
|May 30, 2023
概括
静脉动脉外体膜氧化 (VA ECMO) 转换为静脉动脉静脉ECMO (VAV ECMO) 对差异性缺氧患者至关重要. 早期检测和转换可以提高重症监护机构的生存率.
科学领域:
- 心脏病学 心脏病学
- 临界护理医学 临界护理医学
- 医疗器械 医疗器械
背景情况:
- 静脉动脉外体膜氧化 (VA ECMO) 是严重心脏功能障碍的生命支持措施.
- 接受VA ECMO治疗的患者可能会出现差异性缺氧,需要切换到静脉动脉静脉ECMO (VAV ECMO).
- 目前从VA ECMO转换为VA ECMO的标准还没有明确定义.
研究的目的:
- 在 Gyeongsang 国家大学长医院报告VAV ECMO转换病例.
- 分析需要VAV ECMO支持的患者的结果.
- 突出及时差异性缺氧检测和VAV ECMO转换的重要性.
主要方法:
- 从2017年1月到2019年6月对158名ECMO患者的回顾性审查.
- 鉴定了9名最初接受VA ECMO治疗的患者,由于差异性缺氧,他们需要转换为VA ECMO.
- 分析临床数据,包括转换时间,支持持续时间,呼吸参数和生存率.
主要成果:
- 10.9% (9/82) 的初始VA ECMO患者因差异性缺氧需要转换为VAV ECMO.
- 从VA ECMO启动到VAV ECMO转换的平均时间为2.1天.
- VAV ECMO转换导致峰值吸气压力显著下降,并显示出改善氧化率 (PaO2/FiO2比率) 的趋势.
- 转换为VAV ECMO的患者的整体存活率约为56%.
结论:
- 在VA ECMO患者中迅速识别差异性缺氧是必不可少的.
- 有效转换为VAV ECMO对于改善患者存活率至关重要.
- 这一案例系列强调了VAV ECMO在管理复杂的循环支持需求方面的临床意义.
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