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題 名 | Pulmonary Hemorrhage as a Complication of Extracorporeal Membrane Oxygenation Support for Post-cardiotomy Heart Failure--A Case Report=開心手術後心臟衰竭病嬰接受體外膜氧合支持的肺出血併發症--一病例報告 |
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作 者 | 韓吟宜; 張重義; 柯文哲; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 32:5 民88.09-10 |
頁 次 | 頁224-228 |
分類號 | 417.6231 |
關鍵詞 | 開心手術; 心臟衰竭; 嬰兒; 體外膜氧合; 肺出血; Extracorporeal membrane oxygenation; Cardiac surgery; Pulmonary hemorrhage; |
語 文 | 英文(English) |
中文摘要 | 一位三月大複雜先天性心臟病的男嬰接受開心矯正手術。術中主動脈夾住時間達146分鐘。術後心臟功能不佳,無法脫離心肺機,需要體外膜氧合器暫時支持循環。但使用後發現血液不停地由氣管內管湧出。術後第一天重開手術,發現兩側肺嚴重腫脹出血,左心房室鼓脹且高壓。在以導管將左心房血液引流以減低其壓力,並將血液引流至體外膜氧合器之靜脈端後,肺臟出血自此明顯減少,最後停止。但因兩側肺臟嚴重傷害,病嬰無法脫離膜氧合器之支持。在使用七天後,因多重器官衰竭,存活無望,由醫師停止體外膜氧合器之支持。追究該病例肺出血併發症之原因,乃體外膜氧合器從右心房引流靜脈血,經氧合後,灌入上行主動脈,造成原本己功能不佳的左心室面臨更大的輸出阻力,而惡性循環地使左心室功能更差,最後造成左心室、左心房、肺靜脈及肺微血管之血壓相繼上升,而出現肺出血。因此,心衰竭的病人使用體外膜氧合器時,一定要注意是否有左心脹大及壓力上升而引起的一連串併發症。 |
英文摘要 | A 3-month-old male infant with complex congenital heart defect underwent total surgical correction. Aortic clamp time was 146 minutes. The patient could not be weaned off from cardiopulmonary bypass, and needed veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support. However, blood persistently gushed out of the endotracheal tube after the ECMO use. Reexploration on the first postoperative day found bilateral lung congestion and hemorrage, distended left heart with high pressure. Left atrial vent, was set up to decrease its high pressure, which drained blood to venous route of the ECMO. Pulmonary hemorrhage dramatically decreased thereafter. However, the patient could not be weaned from the ECMO support due to severe bilateral lung damage. Multiple organ failure developed 7 days later, and we turned off the ECMO support because of his grim prognosls. ECMO returned oxygenated blood to the ascending aorta and therefore increased left ventricular afterload in this patient. This further compromised the poor cardiac function, and ensued a vicious cycle. The final result was a distended left heart with high pressure in it. The high pressure transmitted back to pulmonary vessels and caused the pulmonary hemorrhage. Therefore, when ECMO support was used for heart failure, be careful of the complications subsequent to left heart distension and its high pressure and intervention is indicated when it occurs. |
本系統中英文摘要資訊取自各篇刊載內容。