體外循環維生系統在流感併發急性呼吸窘迫症候群之運用

Extracorporeal Membrane Oxygenation for Influenza- Related Acute Respiratory Distress Syndrome

吳梅嵐(Mei-Lan Wu) ； 盧延洲(Yen-Chou Lu) ； 梁雅婷(Ya-Ting Liang) ； 蔡東霖(Tung-Lin Tsai) ； 葉信住(Hsin-Chu Yeh) ； 黃俊立(Chun-Li Huang) ； 賴柏伸(Po-Shan Lai) ； 歐陽志佩(Chih -Pei Ou Yang)

《北市醫學雜誌》 16卷1期 (2019/03) Pp. 60-66

https://doi.org/10.6200/TCMJ.201903_16(1).0007

摘要

目的：重度急性呼吸窘迫症候群本身死亡率極高，此類重症病患若在常規呼吸器與藥物等治療無法改善血氧狀況時，體外循環維生系統（葉克膜；Extracorporeal Membrane Oxygenation；ECMO）可作為挽救性命的治療措施以替代其心肺功能，特別是近幾年因2009年流感病毒大流行所引起的重度急性呼吸窘迫症候群（Acute Respiratory Distress Syndrome；ARDS）病患相關成功治療經驗的累積，葉克膜已逐漸成為這類病患治療的一項標準。本研究旨在報告單一聯合區域醫院以體外循環維生系統治療A型流感併發重度急性呼吸窘迫症候群病患的結果。方法：以回溯性病例方式收集在2016年1月到3月臺灣地區A型流感疫情爆發並併發嚴重急性呼吸窘迫症候在單一聯合區域醫院以葉克膜治療的病患，並追蹤兩年後情況。結果：符合條件的10位病患當中，有3位死亡。有5位併發急性腎損傷，其中3位需要使用連續性腎臟替代療法，有1位併發腸胃道出血，另有3位病患因無法短期內脫離呼吸器而有接受氣管造口手術。最後有7位病患出院。在兩年追蹤期間這七位出院病患並未因肺部相關疾病再次入院。結論：顯示在流感併發重度急性呼吸窘迫症候群使用葉克膜病患在區域醫院亦可提供一定的治療與預後。

關鍵字

體外循環維生系統 ； 葉克膜 ； 流行性感冒 ； 急性呼吸窘迫症候群

並列摘要

Objectives: The mortality rate of acute respiratory distress syndrome (ARDS) is extremely high. More and more studies relating to the ECMO treatment have emerged, especially after the pandemic influenza virus-related ARDS in 2009, and provided promising results of ECMO utilization in such patients. We report the ECMO treatment results of ARDS patients of a single regional hospital during the pandemic period of influenza-A in Taiwan. Methods: The study reviewed retrospectively the medical records of influenza-A infected critically ill patients on ECMO support between January and March, 2016 and their follow-up results for two years. Results: A total of 10 patients fulfilled the criteria and three of them expired. Five patients suffered from acute kidney injuries and of whom 3 required continuous hemodialysis. One patient had gastrointestinal bleeding, and 3 patients received tracheotomy for prolonged ventilator support. The prognosis of these survivors was fair and there was no re-admission for these patients due to pulmonary condition in the following two years. Conclusions: Acceptable treatment result of these patients can be achieved in our regional hospital during the pandemic period.

並列關鍵字

extracorporeal membrane oxygenation (ECMO) ； influenza virus ； adult respiratory distress syndrome