Rescue of Systemic Reperfusion Injury during Arm Replantation by Extracorporeal Membrane Oxygenation

因斷臂接續手術中發生的嚴重系統性再灌流傷害經由葉克膜成功急救

陳世鴻(Shy-Hong Chen) ； 柯文哲(Wen-Je Ko) ； 謝榮賢(Jung-Hsieh Hsieh) ； 范守仁(Shou-Zen Fan) ； 韓吟宜(Yin-Yi Han)

《重症醫學雜誌》 12卷2期 (2011/06) Pp. 75-80

https://doi.org/10.30035/TCCM.201106.0005

摘要

在主要肢體重接續手術中，缺血後再灌流傷害一直是重要的討論。我們將報告一位病患，在因創傷後的斷肢進行接續時經歷危急生命的缺血後再灌流傷害，並且在一般積極治療下仍無法穩定，斷肢在接續後再次切除後仍需設置經靜－動脈體外膜氧合器（靜－動脈葉克膜）以維持病患生命，稍後因接續而來的急性呼吸窘迫症而需再接上經靜－靜脈葉克膜，經由葉克膜我們同時進行連續腎臟替代治療以治療急性腎衰竭引起的無尿，經由此一治療可潛在性地將發炎反應物質和細胞激素移除以利病況的好轉，我們認爲當再灌流傷害產生並且無法控制時使用葉克膜有／無合併連續腎臟替代治療是個好的選擇，即早的使用或可增加斷肢續接手術的成功。

關鍵字

主要斷肢續接 ； 再灌流傷害 ； 體外膜氧合器葉克膜 ； 連續腎臟替代治療

並列摘要

The ischemia-reperfusion (I-R) injury is usually a crucial peri-operative issue for major limbs replantation. We reported a case of attempted arm replantation following its traumatic amputation, who developed life-threatening reperfusion injury refractory to the conventional therapy. Venous-arterial extracorporeal membrane oxygenator (VA ECMO) was set up ultimately to rescue the patient, though re-amputation had been done. Another set of venous-venous mode (VV ECMO) was added later for acute respiratory distress syndrome (ARDS). The continuous renal replacement therapy (CRRT) on each ECMO circuit for anuirc renal failure also potentially enhanced the recovery by removing the inflammatory mediators and cytokines produced along the illness. We postulate that for the major limb replantation, the use of ECMO with/without CRRT could be considered when I-R injury seems uncontrolled, and earlier use may hence provide the chance of successful replantation.

並列關鍵字

Major limbs replantation ； Ischemia-reperfusion injury ； Extracorporeal membrane oxygenator ECMO ； Continuous renal replacement therapy CRRT