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題名 | The Effect of Extracorporeal Membrane Oxygenation Treatment on Patients with Severe Acute Respiratory Distress Syndrome Caused by Influenza Virus=流感病毒性肺炎引起嚴重急性呼吸窘迫症候群病患使用體外循環維生系統支持治療之效果 |
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作者 | 陳彥廷; 許健威; 吳冠陞; 賴瑞生; | 書刊名 | 胸腔醫學 |
卷期 | 28:4 2013.08[民102.08] |
頁次 | 頁200-208 |
分類號 | 415.47 |
關鍵詞 | 急性呼吸窘迫症候群; 重症照護; 流感病毒性肺炎; 體外循環維生系統; Acute respiratory distress syndrome; Critical care; Extracorporeal membrane oxygenation; Influenza viral pneumonia; Mechanical ventilation; |
語文 | 英文(English) |
中文摘要 | 目標:對於流感病毒性肺炎合併嚴重急性呼吸窘迫症候群,比較使用體外循環維生系統與否對於臨床預後之不同。方法:我們回溯性分析這些於西元2008年1月至2011年12月中,曾因流感病毒性肺炎合併嚴重急性呼吸窘迫症候群(PaO2/FiO2 <100 under PEEP >5 cm H2O)而於加護病房接受治療之病患,並比較分析其曾接受體外循環維生系統支持治療與否的病患臨床特徵及預後。結果:全部有13位病患被納入分析,其中11位乃經由聚合酵素鏈鎖反應證實感染(8位為A型流行性感冒(swH1),2位為A型流行性感冒(H3),1位為B型流行性感冒),1位經由流感快速篩檢測試證實為A型流行性感冒,1位經由支氣管肺泡灌洗術病毒分離證實為A型流行性感冒。其中6位病患接受靜脈循環式的體外循環維生系統治療,其他7 位病患僅接受傳統呼吸器支持治療。在接受體外循環維生系統治療對於沒有使用體外循環維生系統的病患有較高的呼吸器脫離率(83.3% vs. 29%, p=0.048)還有較低的死亡率,雖然沒有達到統計學上的意義。結論:對於這些流感病毒性肺炎合併嚴重急性呼吸窘迫症候群病患,體外循環維生系統的使用於那些難矯正的低血氧或許是個有效的治療策略,並且可以提供病患之後較好的呼吸器脫離率,較低的死亡率及較佳的長期預後之趨勢。 |
英文摘要 | Objectives: We compared the clinical outcomes of patients with virus pneumonia and severe acute respiratory distress syndrome (ARDS) status treated with or without extracorporeal membrane oxygenation (ECMO) support.Methods: We retrospectively reviewed the hospital courses of patients who were admitted to intensive care unit (ICU) with severe ARDS (PaO2/FiO2 <100 under positive end expiratory pressure >5 cmH2O) due to influenza virus pneumonia and who had a period ≤7 days between the onset of influenza and intubation from January 2008 to December 2011. Clinical characteristics and outcomes were compared between patients with and without ECMO support.Results: A total of 13 patients with refractory hypoxemia and severe ARDS status were enrolled. Eleven of the 13 patients had a diagnosis of influenza confirmed by PCR test (8 influenza A (swH1), 2 influenza A (H3) and 1 influenza B), 1 by the influenza rapid test (influenza A) and 1 by bronchoalveolar lavage (BAL) virus isolation (influenza A). Six patients were provided with veno-venous ECMO (vv-ECMO) support and 7 patients received only conventional ventilatory support. Patients who were provided with ECMO support had a higher successful ventilator weaning rate (83.3% vs. 29%, p=0.048) than patients without ECMO support. The hospital mortality rate between patients with and without ECMO support did not differ (17% vs. 57%, p=0.135).Conclusions: In patients with influenza virus pneumonia-related severe ARDS, ECMO support may be an effective rescue treatment strategy for refractory severe hypoxemia and lead to a significantly higher successful ventilator weaning rate, a lower hospital mortality rate, and better long-term outcome. |
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