背景:静脉静脉体外膜氧合(V-VECMO)已成为重症肺炎的重要治疗方法,但是在治疗过程中有各种并发症。本文介绍了一例通过V-VECMO成功治疗的重症肺炎病例。但在治疗过程中,后静脉导管,应该在右内静脉,直接在纵隔进入上腔静脉。经多学科协商后,ECMO安全撤出。我们对此案的经验有望为遇到类似情况的同事提供参考。
方法:一名64岁的男性患有严重的肺部感染和呼吸衰竭。他被送进了我们的医院,并接受了通气支持(吸入氧气的比例为100%)。呼吸衰竭没有改善,他接受了V-VECMO治疗,在此期间静脉回流导管,应该在右内静脉,直接在纵隔进入上腔静脉。如果在撤除ECMO时直接拔除导管,则存在纵隔大量出血的风险。最后,在多学科会诊后,患者在手术室接受了腔静脉血管造影+球囊附着+ECMO撤药(准备在手术期间随时转换为开胸手术进行血管探查和修复).ECMO被安全撤出,病人康复出院。
结论:患者可能有不同的血管疾病。多学科合作可以确保患者安全。我们的经验将为类似案例提供参考。
BACKGROUND: Venovenous extracorporeal membrane oxygenation (V-V ECMO) has become an important treatment for severe pneumonia, but there are various complications during the treatment. This article describes a
case with severe pneumonia successfully treated by V-V ECMO, but during treatment, the retrovenous catheter, which was supposed to be in the right internal vein, entered the superior vena cava directly in the mediastinum. The ECMO was safely withdrawn after multidisciplinary consultation. Our experience with this
case is expected to provide a reference for colleagues who will encounter similar situations.
METHODS: A 64-year-old man had severe pulmonary infection and respiratory failure. He was admitted to our hospital and was given ventilation support (fraction of inspired oxygen 100%). The respiratory failure was not improved and he was treated by V-V ECMO, during which the venous return catheter, which was supposed to be in the right internal vein, entered the superior vena cava directly in the mediastinum. There was a risk of massive mediastinal bleeding if the catheter was removed directly when the ECMO was withdrawn. Finally, the patient underwent vena cava angiography + balloon attachment + ECMO withdrawal in the operating room (prepared for conversion to thoracotomy for vascular exploration and repair at any time during surgery) after multidisciplinary consultation. ECMO was safely withdrawn, and the patient recovered and was discharged.
CONCLUSIONS: Patients may have different vascular conditions. Multidisciplinary cooperation can ensure patient safety. Our experience will provide a reference for similar cases.