摘要
目的总结体外膜肺氧合(ECMO)与连续肾脏替代疗法(CRRT)一体化支持的管理体会。方法回顾性分析4例先天性心脏病术后接受ECMO与CRRT一体化治疗患儿临床资料,其中男3例,女1例,体质量(3.3~12.6)kg;诊断为大动脉转位(TGA)2例,其中行腔肺吻合手术后1例,完全性肺静脉异位引流(TAPVC)1例,肺动脉闭锁(PA)1例。结果痊愈出院2例,死亡2例,其中1例死于弥散性血管内凝血,1例死于循环衰竭。ECMO与CRRT一体化治疗后24 h,正性肌力药物评分、血乳酸、脑利钠肽、肌酐显著降低,动脉血压显著增高。结论 ECMO与CRRT一体化治疗是治疗心、肺、肾功能衰竭患者的重要手段。医护人员需要从管道管理、液体平衡、凝血与抗凝、循环、呼吸系统等多方面细致观察,严格遵守无菌操作,减少并发症的发生。
Objective To summarize the experience of extracorporeal membrane oxygenation（ECMO） combined with continuous renal replacement therapy（CRRT）.Methods A retrospective analysis of 4 cases of congenital heart disease after surgery received ECMO and CRRT integrated treatment in patients with clinical data,including male 3 cases,female 1cases,body weight（3.3-12.6） kg;diagnosis of transposition of the great arteries（TGA） in 2 cases,of which 1 cases underwent pulmonary anastomosis after operation;pulmonary venous drainage（TAPVC） in 1 cases,pulmonary atresia（PA） in1 cases.Results Of the 4 patients,2 patients were cured and discharged,2 patients died,1 of them died of Disseminated intravascular coagulation,and the other died of circulatory failure.At 24 hours after integrated treatment of ECMO and CRRT,the inotropic score,blood lactate,brain natriuretic peptide and serum creatinine were decreased significantly,and arterial blood pressure increased significantly.Conclusion Combination of ECMO and CRRT is an important method for treatment of patients with heart,respiratory and renal failure.The medical staff should carefully observe extracorporeal circuit,fluid balance,coagulation and anticoagulation,cardiac,and respiratory system,strictly obey aseptic technique and reduce the incidence of complications.
作者
邹文艳
黄继红
ZOU Wenyan HUANG Jihong.(Department of Thoracic and Cardiovascular Surgery, Shanghai Children＇ s Medical Center, School of Medicine , Shanghai Jiao Tong University,Shanghai 200127, China)
出处
《疑难病杂志》
CAS
2017年第5期515-518,共4页
Chinese Journal of Difficult and Complicated Cases
基金
上海交通大学医工交叉基金项目(YG2014MS64)
关键词
体外膜肺氧合
连续肾脏替代疗法
先天性心脏病
Extracorporeal membrane oxygenation
Continuous renal replacement therapy
Congenital heart disease
