Early Active Rewarming by Extracorporeal Membrane Oxygenation in an Hypothermia Patient

低體溫可以發生於任何季節和氣候，又可因失去調節的惡性循環而加重其對血行循環的抑制，而其在臨床的表現從輕微的意識障礙至嚴重的休克都有可能發生。在面對嚴重低體溫的病人，更是對臨床工作者的一大挑戰，因其常常會併發循環和神經的障礙，和有著相當高的死亡率。因此在面對嚴重低體溫的病人，應儘速建立主動較侵入性回溫的治療，而在嚴重低體溫且又併發心血管不穩定的情況時，體外循環的建立是最直接有效的方法，而葉克膜的使用更優於體外循環，因其較可迅速有效的建立且具較少的併發症。在此一疑似因環境因素造成嚴重失溫的案例，除遵循面對低體溫的標準流程處理，在發現其意識及循環不穩定的同時，積極儘速的使用葉克膜來治療其低體溫並維持其生命徵象的穩定。而這名病人的體溫在使用葉克膜後，馬上有了迅速穩定的回溫，在意識和循環穩定控制後，葉克膜於使用42小時後移除，而病人亦在加護病房接受升壓劑治療並觀察確定無相關併發症，於五日後轉入一般病房。

關鍵字

低體溫；循環障礙；葉克膜；主動內部回溫；葉克膜體外維生系統

並列摘要

Hypothermia can happen in any climate or in any weather conditions, and the vicious cycle of hypothermia may exacerbate circulatory inhibition. The clinical manifestations might range from mild conscious disturbances to severe shock. Thus, it is a great challenge for clinicians to manage patients with severe hypothermia. Active invasive rewarming procedure should be initiated as soon as possible for severe hypothermic patients. Extracorporeal membrane oxygenation (ECMO) is the most direct and effective method for the severe hypothermic patient with hemodynamic instability. Moreover, ECMO is superior than cardiopulmonary bypass because ECMO can be established more rapidly and has less complications. In presenting a case of severe environmental hypothermia, we treated the patient using standard procedures and prescribed ECMO as soon as possible while consciousness and vital signs were unstable. The active rewarming system with ECMO had a rapid effect on the patient, and ECMO was removed after 42 hours when consciousness and the circulation had stabilized. The patient was kept under close observation in the intensive care unit and received inotropic agents. She was transferred to the medical ward with no relative complications 5 days after admission.

並列關鍵字

hypothermia ； circulatory impairment ； ECMO ； active internal rewarming ； extracorporeal membrane oxygenation

國際替代計量

Early Active Rewarming by Extracorporeal Membrane Oxygenation in an Hypothermia Patient

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