论文部分内容阅读
目的:比较在肺移植手术中行静脉-动脉体外膜肺氧合（VA-ECMO）辅助过程中应用不同静脉插管引流对改善患者全身氧合状态疗效的差异。方法:选择河南省人民医院2016年12月至2019年12月行单肺移植术中应用VA-ECMO辅助的12例患者为研究对象。根据所使用静脉插管侧孔的多少分为少侧孔静脉插管组和多侧孔静脉插管组，每组6例。比较两组患者辅助前后右侧桡动脉、左侧桡动脉、右颈内静脉血气指标的差异，评价辅助效果。结果:两组患者右侧和左侧桡动脉辅助后动脉血氧分压（PaOn 2）均较辅助前明显升高〔mmHg（1 mmHg＝0.133 kPa）：少侧孔静脉插管组右侧桡动脉为79.5±4.2比48.3±3.8，左侧桡动脉为88.1±3.5比48.3±3.8；多侧孔静脉插管组右侧桡动脉为67.7±5.9比48.7±3.2，左侧桡动脉为84.0±3.8比48.7±3.2，均n P<0.05〕，动脉血二氧化碳分压（PaCOn 2）均较辅助前明显降低（mmHg：少侧孔静脉插管组右侧桡动脉为44.2±2.6比71.7±4.4，左侧桡动脉为44.7±1.4比71.7±4.4；多侧孔静脉插管组右侧桡动脉为46.2±2.1比71.2±3.5，左侧桡动脉为44.1±1.9比71.2±3.5，均n P<0.05）。少侧孔静脉插管组患者辅助后ECMO系统静脉引流管处血气分析指标静脉血氧分压（PvOn 2）明显低于多侧孔静脉插管组（mmHg：56.4±3.2比88.7±1.5，n P<0.01），静脉血二氧化碳分压（PvCOn 2）明显高于多侧孔静脉插管组（mmHg：63.6±3.7比44.2±1.7，n P<0.01）。n 结论:在肺移植手术行VA-ECMO辅助时，通过使用少侧孔的静脉插管充分引流上腔血流，能更有效地改善肺移植患者上半身氧合情况，避免了上半身低氧合、下半身高氧合的窘境，可为单肺移植患者进行更加有效的辅助，对改善患者全身的氧合状态更有意义。“,”Objective:To compare the curative effects of different venous cannulas and drainage to improve patient\'s whole body oxygenation during the auxiliary process of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in lung transplantation.Methods:From December 2016 to December 2019, 12 patients who were assisted by VA-ECMO in one lung transplantation in People\'s Hospital of Henan Province were selected as the research objects. According to the number of side holes of venous cannulas, they were divided into two groups: one group with few side holes and other group with multiple side holes. The differences in blood gas indexes among the right radial artery, left radial artery, and right internal jugular vein before and after assistance were compared, and the assistance effect was evaluated.Results:The arterial partial pressure of oxygen (PaOn 2) of blood gas indexes of the right and left radial arteries in both groups were significantly higher than that before assistance [mmHg (1 mmHg = 0.133 kPa): right and left radial artery in few side holes group: 79.5±4.2 vs. 48.3±3.8 and 88.1±3.5 vs. 48.3±3.8; right and left radial artery in multiple side holes group: 67.7±5.9 vs. 48.7±3.2 and 84.0±3.8 vs. 48.7±3.2, all n P < 0.05]. The arterial partial pressure of carbon dioxide (PaCO n 2) of blood gas index was significantly lower than that before assistance (mmHg: 44.2±2.6 vs. 71.7±4.4 for the right radial artery and 44.7±1.4 vs. 71.7±4.4 for the left radial artery in the group with few side holes; 46.2±2.1 vs. 71.2±3.5 for the right radial artery and 44.1±1.9 vs. 71.2±3.5 for the left radial artery in the group with multiple side holes, all n P < 0.05). The partial pressure of oxygen in venous blood (PvO n 2) of blood gas index of ECMO system in the group with few side holes was significantly lower than that of the multiport side holes group (mmHg: 56.4±3.2 vs. 88.7±1.5, n P < 0.01), and the partial pressure of carbon dioxide in venous blood (PvCO n 2) was significantly higher than that of multiport side holes group (mmHg: 63.6±3.7 vs. 44.2±1.7, n P < 0.01).n Conclusions:When VA-ECMO is used in lung transplantation, the superior vena cava blood flow can be fully drained by using intravenous cannula with few side holes. It can effectively improve the oxygenation of the upper body of lung transplant patients, avoid the dilemma of hypoxemia in the upper body and hyperxemia in the lower body, provide more effective assistance to patients undergoing single lung transplantation, and is more meaningful for improving the oxygenation status of the whole body in patients undergoing single lung transplantation.