ECMO联合IABP治疗心源性休克过程中膜肺水肿导致低氧血症1例报告及文献复习

doi:10.13481/j.1671-587X.20220628

摘要/Abstract

摘要：

目的分析体外膜氧合（ECMO）联合主动脉球囊反搏（IABP）治疗过程中患者低氧血症的临床表现和治疗方式，提高临床医生对ECMO联合IABP治疗过程中低氧血症的处理、鉴别及分析能力。方法收集1例采用ECMO和IABP支持治疗心源性休克伴发低氧血症患者的临床资料，分析患者低氧血症的原因和治疗方式，并进行相关文献复习。结果患者，男性，48岁，因阵发性心前区疼痛1 d，加重4 h入院。住院后1 h行冠脉造影，见前降支近段闭塞，给予前降支支架植入。患者术中血压92/60 mmHg，心率110 min^－1，安装IABP（1∶1反搏）。患者术后第2天出现心力衰竭，常规强心和利尿治疗后症状不缓解转入重症监护病房（ICU）行ECMO支持治疗。ECMO支持第2天，突然出现呼吸和循环症状加重（心率上升至150~160 min^－1，血压下降至98/79 mmHg，呼吸频率上升至35 min^－1），经皮脉氧饱和度（SpO₂）下降至89%。床旁超声检查，心脏心室壁搏动弱，左心室饱满。经排查后考虑为膜肺水肿和IABP反搏频率过高所致。调整机械通气设置提高氧合状态，同时将ECMO气流量调整至10 L·min^－1，膜肺排气孔排出大量水滴；将IABP反搏频率设置为1∶2后患者病情明显缓解，最后成功撤除ECMO和IABP，患者康复出院。结论辅助设备的无报警故障和设置不当可导致设备支持力度下降、患者病情加重；发生问题时应优先维持患者的生命体征，迅速排查辅助设备的故障。

关键词: 心源性休克, 体外膜氧合, 主动脉球囊反搏, 膜肺水肿, 低氧血症

Abstract:

Methods The clinical data of one patient with cardiogenic shock complicated with hypoxemia treated with ECMO and IABP were collected， the etiology and treatment method of hypoxemia were analyzed， and the related literatures were reviewed. Results The patient，48-year-old male， was hospitalized because of paroxysmal precordial pain for 1 d and exacerbation for 4 h. The coronary angiography was performed 1 h after hospitalization，and the proximal anterior descending branch occlusion was found，and the anterior descending branch stent was implanted. The patients’s intraoperative blood pressure was 92/60 mmHg and the heart rate was 110 min^－1， and the IABP （1∶1 counterpulsation） was installed. The heart failure occurred in the patient on the second day after operation，and the patient failed the routine cardiotonic and diuretic treatments and was transferred to Intensive Care Unit （ICU） Department for the ECMO support. On the second day of ECMO support， the patient had a sudden aggravation in the circulation and respiration （the heart rate was raised up to 150－160 min^－1，the blood pressure was dropped to 98/79 mmHg，the respiratory rate was increased to 35 min^－1）， and the percutaneous arterial oxygen saturation （SpO₂） was dropped to 89%. The bedside ultrasound examination results showed that and there was a weak motivation of ventricular of heart and the left ventricle was full.After investigation， it was considered to be caused by membranous pulmonary edema and high frequency of the IABP counterpulsation. The oxygenation state was obviously improved after optimizing the mechanical ventilation setting，the ECMO sweep flow was switched to 10 L·min^－1， and a mass of water droplets were discharged from the membrane exhaust hole；after the IABP counterpulsation frequency was set as 1∶2， the patient’s condition was significantly relieved； finally the ECMO and IABP were successfully removed， and the patient recovered and was discharged from hospital. Conclusion The non-alarm malfunction and improper setting of the extracorporeal equipment can lead to the decreasing of the support performance and aggravation of the disease； when the abnormity occurs， the essential vital signs of the patient should be maintained， then the malfunctions of the equipment should be checked quickly. Objective To analyze the clinical manifestations and treatment method of hypoxemia patients treated with of extracorporeal membrane oxygenation （ECMO） combined with aortic balloon pump （IABP），and to improve the management， identification and analysis abilities of the clinicians for hypoxemia during the treatment of ECMO combined with IABP.

Key words: Cardiogenic shock, Extracorporeal membrane oxygenation, Intra-aortic balloon pump, Membrane edema, Hypoxemia

中图分类号:

R654.1

顾明,田加坤,赵亚男,孙键,张京晓,宋德彪. ECMO联合IABP治疗心源性休克过程中膜肺水肿导致低氧血症1例报告及文献复习[J]. 吉林大学学报(医学版), 2022, 48(6): 1599-1604.

Ming GU,Jiakun TIAN,Yanan ZHAO,Jian SUN,Jingxiao ZHANG,Debiao SONG. Hypoxemia induced by membrane edema during ECMO combined with IABP in treatment of cardiogenic shock： A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2022, 48(6): 1599-1604.

图/表 2

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