无泵体外人工肺辅助技术在治疗严重、难治性哮喘持续状态中的作用
2010/12/31
摘要
背景：目前，针对严重、难治性哮喘持续状态，旨在去除二氧化碳，保护肺组织的唯一治疗方法是，体外泵驱动的膜氧合(ECMO)。对于这些患者，无泵体外人工肺辅助技术(pECLA)也是一个备选方法。
病例报道：一名42岁女性哮喘患者，因哮喘急性恶化而急诊就诊。尽管采用了最佳的药物治疗，患者仍然出现呼吸衰竭，需要机械通气增加气道压力。对于严重的通气-难治性高碳酸血症和呼吸性酸中毒患者，初始使用ECMO，随后采用pECLA 治疗。在治疗过程中，患者出现持续的改善，肺部气体交换完全。8天后去除pECLA，患者成功脱离机械通气。
结论：该报道显示，对于严重、难治性哮喘持续状态导致通气-严重高碳酸血症和呼吸性酸中毒，pECLA可作为备选方案。
（刘国梁 审校）
J Asthma. 2010 Nov 1. [Epub ahead of print]
Pumpless Extracorporeal Lung Assist for the Treatment of Severe, Refractory Status Asthmaticus.
Jung C, Lauten A, Pfeifer R, Bahrmann P, Figulla HR, Ferrari M.
Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany.
Abstract
Background. Until recently, the only available lung-protective treatment option for carbon dioxide removal due to severe, refractory status asthmaticus has been extracorporeal pump-driven membrane oxygenation (ECMO). Pumpless extracorporeal lung assist (pECLA) may serve as an alternative therapy for these patients. Case Report. A 42-year-old woman presented with an acute exacerbation of asthma to our Emergency Department. Despite optimal pharmacological therapy, the patient developed respiratory failure requiring mechanical ventilation with elevated airway pressures. For severe ventilation-refractory hypercapnia and respiratory acidosis, ECMO was used initially and was later replaced by a pECLA device. The clinical condition continuously improved with sufficient pulmonary gas exchange. The pECLA was removed after 8 days, and the patient was successfully weaned from mechanical ventilation.
Conclusions. This report suggests that pECLA is an alternative extracorporeal lung assist in patients with ventilation-refractory hypercapnia and respiratory acidosis due to severe, refractory status asthmaticus.
J Asthma. 2010 Nov 1. [Epub ahead of print]
背景：目前，针对严重、难治性哮喘持续状态，旨在去除二氧化碳，保护肺组织的唯一治疗方法是，体外泵驱动的膜氧合(ECMO)。对于这些患者，无泵体外人工肺辅助技术(pECLA)也是一个备选方法。
病例报道：一名42岁女性哮喘患者，因哮喘急性恶化而急诊就诊。尽管采用了最佳的药物治疗，患者仍然出现呼吸衰竭，需要机械通气增加气道压力。对于严重的通气-难治性高碳酸血症和呼吸性酸中毒患者，初始使用ECMO，随后采用pECLA 治疗。在治疗过程中，患者出现持续的改善，肺部气体交换完全。8天后去除pECLA，患者成功脱离机械通气。
结论：该报道显示，对于严重、难治性哮喘持续状态导致通气-严重高碳酸血症和呼吸性酸中毒，pECLA可作为备选方案。
（刘国梁 审校）
J Asthma. 2010 Nov 1. [Epub ahead of print]
Pumpless Extracorporeal Lung Assist for the Treatment of Severe, Refractory Status Asthmaticus.
Jung C, Lauten A, Pfeifer R, Bahrmann P, Figulla HR, Ferrari M.
Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany.
Abstract
Background. Until recently, the only available lung-protective treatment option for carbon dioxide removal due to severe, refractory status asthmaticus has been extracorporeal pump-driven membrane oxygenation (ECMO). Pumpless extracorporeal lung assist (pECLA) may serve as an alternative therapy for these patients. Case Report. A 42-year-old woman presented with an acute exacerbation of asthma to our Emergency Department. Despite optimal pharmacological therapy, the patient developed respiratory failure requiring mechanical ventilation with elevated airway pressures. For severe ventilation-refractory hypercapnia and respiratory acidosis, ECMO was used initially and was later replaced by a pECLA device. The clinical condition continuously improved with sufficient pulmonary gas exchange. The pECLA was removed after 8 days, and the patient was successfully weaned from mechanical ventilation.
Conclusions. This report suggests that pECLA is an alternative extracorporeal lung assist in patients with ventilation-refractory hypercapnia and respiratory acidosis due to severe, refractory status asthmaticus.
J Asthma. 2010 Nov 1. [Epub ahead of print]
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