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Received:April 15, 2020 Published Online:July 20, 2020
Received:April 15, 2020 Published Online:July 20, 2020
中文摘要: 目的 探讨体外膜肺氧合(ECMO)在危重型新型冠状病毒肺炎患者中使用的有效性和时机。
方法 收集2020年1月1日至3月1日在武汉大学中南医院急救中心隔离病房确诊且行ECMO治疗的危重型新型冠状病毒肺炎患者,统计并分析其基本信息、流行病学、临床表现、实验室检查、影像学资料、常规治疗情况、ECMO应用情况及临床转归。
结果 5例行ECMO支持的患者均有流行病学接触史,4例男性,1例女性。入隔离病房时均发热,4例体温超过38.5 ℃。3例患者入隔离病房时为重度急性呼吸窘迫综合征(ARDS),均出现淋巴细胞减少,降钙素原升高。胸部CT影像均表现为双侧多发的胸膜下磨玻璃影。除ECMO支持外,均接受了氧疗、抗病毒、经验性抗生素及糖皮质激素治疗。3例患者存活,应用ECMO支持的呼吸系统疾病存活预测评分(RESP)为4~7分,从重度ARDS到应用ECMO时间≤10 h。2例患者死亡,其中1例因脑出血死亡,RESP评分4分;1例因气胸、脓胸合并多器官功能衰竭死亡,RESP评分-1分;从重度ARDS到应用ECMO时间分别为185 h和576 h。
结论 ECMO对危重型新型冠状病毒肺炎患者的救治是有效的,发展为重度ARDS后ECMO的早期应用可能改善患者预后。
中文关键词: 新型冠状病毒肺炎,危重型 新型冠状病毒 体外膜肺氧合
Abstract:Objective To investigate the efficacy and timing of the extracorporeal membrane oxygenation (ECMO) in patients with critical COVID-19.
Methods The patients who diagnosed with critical COVID-19 and treated with ECMO in the isolation ward of Emergency Center,Zhongnan Hospital of Wuhan University from January 1st,2020 to March 1st,2020 were selected.The basic information,epidemiology,clinical manifestation,laboratory examination,imaging data,routine treatment,ECMO application and clinical outcome were collected and analyzed.
Results All the 5 patients with ECMO support had a history of epidemiological exposure,including 4 males and 1 female.All the patients entered the isolation ward with fever.The body temperature of 4 patients was over 38.5 ℃.Severe acute respiratory distress syndrome (ARDS) was found in 3 patients,all of them showed decreased lymphocyte and increased procalcitonin.CT images of the chest showed multiple subpleural ground glass shadows on both sides.In addition to ECMO support,all patients received oxygen therapy,antiviral,empirical antibiotics and glucocorticoid therapy.Three patients survived,and their RESP score supported by ECMO was 4-7,and the time from severe ARDS to ECMO application was less than or equal to 10 hours.Two patients died,one of them died of cerebral hemorrhage,RESP score was 4 points,one died of pneumothorax and empyema combined with multiple organ failure,RESP score was -1 point;the time from severe ARDS to ECMO application was 185 h and 576 h respectively.
Conclusions ECMO is effective in the treatment of critical COVID-19 patients.The early application of ECMO after severe ARDS can improve the prognosis of patients.
文章编号: 中图分类号: 文献标志码:B
基金项目:湖北省临床医学研究中心建设项目(2019-07)
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