心包膜填塞導致呼吸衰竭使用體外膜氧合及肺保護策略之呼吸照護經驗

Cardiac tamponade leads to respiratory failure using Extracorporeal Membrane Oxygenation and Protective lung strategy for respiratory care experience

蘇庭萱(SU-TING-HSUAN) ； 吳庚欽(WU-GENG-QIN)

《呼吸治療》 20卷1期 (2021/01) Pp. 33-40

https://doi.org/10.6269/JRT.202101_20(1).0004

摘要

本文敘述一位因急性心肌梗塞，心導管檢查後突發性血管破裂，導致急性心包填塞，大量心包膜積液引發心因性休克及心因性肺水腫。因引流出大量心包膜積血，行開胸止血，輸注大量輸液後導致急性呼吸窘迫，予以機械通氣與肺保護策略及體外膜氧合治療處置的成功案例。肺保護策略經過臨床實證是廣泛被運用且安全改善氧合的方法，但過去大多都用於急性呼吸窘迫症候群的病患，對於非呼吸窘迫症候群使用體外膜氧合合併嚴重低血氧的病患上，並無明確相關建議。故想藉由非呼吸窘迫症候群導致嚴重低血氧病患使用肺保護策略機械通氣及體外膜氧合治療技術做更深入的探討。

關鍵字

心包填塞 ； 體外膜氧合 ； 肺保護策略 ； 非呼吸窘迫症候群

並列摘要

The article is about a successful clinical case of using mechanical ventilation with protective lung strategy and extracorporeal membrane oxygenation. In the case, the patient was diagnosed with acute cardiac tamponade. Such a massive amount of hemorrhage lead to cardiogenic shock and cardiogenic pulmonary edema caused by cardiac vascular rupture after cardiac catheterization of acute myocardial infarction. The need of fluid challenge due to massive amount of hemorrhage and thoracotomy hemostasis caused respiratory failure. Lung protection strategy is proved to be a widely used and safe way to improve oxygenation, but it used mostly in acute respiratory distress syndrome in the past. To the use of extracorporeal membrane oxygenation with severe hypoxemia in non-respiratory distress syndrome has no certain related recommendations. Therefore, I would like to explore the use of lung protection strategy mechanical ventilation and extracorporeal membrane oxygenation therapy to severe hypoxemia patients with non-respiratory distress syndrome and make further discussion of improvement of oxygenation trough this case.

並列關鍵字

cardiac tamponade ； extracorporeal membrane oxygenation(ECMO) ； protective lung strategy ； non-acute respiratory distress syndrome