危重患者在體外膜肺氧合支持下院間轉(zhuǎn)運(yùn)的病例系列報(bào)道

摘要： 目的總結(jié)我院體外膜肺氧合(extracorporeal membrane oxygenation,ECMO)團(tuán)隊(duì)對(duì)10例外院危重患者實(shí)施ECMO支持下院間轉(zhuǎn)運(yùn)的臨床結(jié)果和經(jīng)驗(yàn)。方法收集2016年6月至2018年1月我院ECMO團(tuán)隊(duì)對(duì)10例外院危重患者實(shí)施ECMO支持下院間轉(zhuǎn)運(yùn)的臨床資料,對(duì)患者的轉(zhuǎn)運(yùn)距離、轉(zhuǎn)運(yùn)并發(fā)癥及治療結(jié)果進(jìn)行總結(jié)。結(jié)果 10例ECMO患者的轉(zhuǎn)運(yùn)距離為3. 4～248. 0 km,平均72. 6 km。轉(zhuǎn)運(yùn)過(guò)程中1例靜脈-靜脈(V-V) ECMO患者靜脈管道扭曲,影響ECMO流量;2例靜脈-動(dòng)脈(V-A)ECMO患者切口滲血。10例患者都安全到達(dá)我院。1例患者治愈出院;1例患者成功撤除ECMO,后因肺部感染、多器官功能衰竭死亡;1例患者死亡;2例患者家屬最后放棄治療,自動(dòng)出院;另外5例供體均成功獲取肝臟和(或)腎臟。結(jié)論在ECMO支持下院間轉(zhuǎn)運(yùn)危重患者可以安全地進(jìn)行,并發(fā)癥可控;相關(guān)人員應(yīng)重視ECMO多學(xué)科團(tuán)隊(duì)建設(shè)并規(guī)范操作流程。
Objective To summerize the clinical outcomes and experience of extracorporeal membrane oxygenation(ECMO)-supported inter-hospital transport for critically ill patients. Methods Clinical data of 10 critically ill patients undergoing ECMO-supported inter-hospital transport by our ECMO team during June 2016 and January 2018 were collected in this study. The transport distance,transport complications and treatment outcomes were summarized. Results The transport distance of 10 cases was 3. 4to 248. 0 km,at an average of 72. 6 km. During the transportation,1 case of V-V ECMO patients(drainage from the right femoral vein and reflux to the right internal jugular vein) had twist of venous tubes,which affected ECMO flow,and 2 cases of V-A ECMO patients(drainage from the right femoral vein and reflux to the right femoral artery) had incision bleeding. All of the 10 cases safely reached our hospital. One patient was cured and discharged,1 was successfully removed from ECMO but died of pulmonary infection and multiple organ failure,1 patient died,2 patients discharged from hospital by themselves because their family finally gave up the treatment,and the left 5 patients became brain death donors for the liver and/or kidneys.Conclusion Inter-hospital transport on ECMO can be safely performed in critically ill patients,and the complications associated with ECMO transport can be controlled. The staffs involved should pay attention to the construction of ECMO multidisciplinary team and standardize the operating procedures.