Extracorporeal Membrane Oxygenation (ECMO) 體外膜肺氧合（ECMO） 【overview】 ECMO stands for extracorporeal membrane oxygenation. The ECMO machine is similar to the heart-lung by-pass machine used in open-heart surgery. It pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest. When you are connected to an ECMO, blood flows through tubing to an artificial lung in the machine that adds oxygen and takes out carbon dioxide; then the blood is warmed to body temperature and pumped back into your body. ECMO指體外膜肺氧合。ECMO機器類似于心臟手術中使用的心肺旁路機，它在體外將患者的血液氧合后再回泵，使心肺得到休息。當人體連接到ECMO時，血液通過管道流入人工肺，在此過程中補充氧氣并排出二氧化碳，接著血液被加熱至體溫，再泵回人體。 There are two types of ECMO. The VA ECMO is connected to both a vein and an artery and is used when there are problems with both the heart and lungs. The VV ECMO is connected to one or more veins, usually near the heart, and is used when the problem is only in the lungs. ECMO有兩種類型。VA-ECMO連接動靜脈，用于心肺聯(lián)合替代；VV-ECMO連接一至多條靜脈，通常是靠近心臟的靜脈，用于單純肺功能受損。 UCSF is also now using a smaller portable ECMO device that is light enough to be carried by one person and can be transported in an ambulance or helicopter, making it possible to provide ECMO relief in emergency cases. 美國加州大學舊金山分校(University of California at San Francisco，UCSF）現(xiàn)在也使用一種可單人操作的小型便攜式ECMO設備，并可用救護車或直升機運送,使得緊急情況下提供ECMO救助成為可能。 Machines designed to provide extracorporeal membrane oxygenation (ECMO) have been in use since the early 1970s—and are often associated with newborns in respiratory distress. But in an effort to save more lives, UCSF physicians have begun using the technology earlier and with a broader range of patients than in the past. What distinguishes the use of ECMO at UCSF is the patients we select and the point at which we choose to use it. 提供體外膜肺氧合(ECMO)的機器自1970年代初就開始投入使用，常與新生兒呼吸窘迫相關。但是為了拯救更多的生命，UCSF的醫(yī)生比過去更早且更廣泛應用這項技術。UCSF使用ECMO的不同之處在于選擇何種患者和選擇何時開始。 When is ECMO used: ?For patients recovering from heart failure, or lung failure or heart surgery. ?As a bridge option to further treatment, when doctors want to assess the state of other organs such as the kidneys or brain before performing heart or lung surgery. ?For support during high-risk procedures in the cardiac catheterization lab. ?As a bridge to a heart assist device, such as left ventricular assist device (LVAD). ?As a bridge for patients awaiting lung transplant. The ECMO helps keep tissues well oxygenated, which makes the patient a better candidate for transplant. 何時使用ECMO： ?用于心臟衰竭、肺功能衰竭或接受心臟外科手術的患者。 ?當醫(yī)生們希望在進行心肺手術之前評估其他器官，如腎臟或大腦的狀態(tài)時，可作為進一步治療的橋接選擇。 ?在心臟導管室的高危操作過程中給予支持。 ?作為心臟輔助裝置的橋接，如左心室輔助裝置（LVAD）。 ?作為等待肺移植患者的橋接措施。ECMO能保持組織較好氧合，使患者更適合接受移植。 【Procedure】 Being placed on ECMO requires a surgical procedure but it is usually done in a patient's room. The patient is sedated and given pain medication and an anti-coagulant to minimize blood clotting. A surgeon, assisted by an operating room team, inserts the ECMO catheters into either an artery or veins. An x-ray is then taken to ensure the tubes are in the right place. Usually a patient on the ECMO pump will also be on a ventilator, which helps the lungs to heal. While on ECMO, the patient will be monitored by specially trained nurses and respiratory therapists, as well as the surgeon and surgical team. Since you will be sedated and have a breathing tube in place, supplemental nutrition will be provided either intravenously or though a nasal-gastric tube. 【過程】 放置ECMO需要手術，但通常是在病房進行。病人服用鎮(zhèn)靜劑、止痛藥和抗凝劑以減少血液凝固。外科醫(yī)生在手術室團隊協(xié)助下，將ECMO導管插入動脈或靜脈。然后拍x光片以確保管子放置在正確的位置。通常情況下，使用ECMO的患者也會使用呼吸機，這有助于肺部恢復，在這過程中，病人將由受過專門訓練的護士和呼吸治療師共同監(jiān)護，此外還有外科手術團隊。由于病人將被麻醉，并且放置呼吸管，營養(yǎng)將通過靜脈或鼻胃管進行補充。 While on ECMO, you may be given certain medications including: heparin to prevent blood clots; antibiotics to prevent infections; sedatives to minimize movement and improve sleep; diuretics to help the kidney get rid of fluids; electrolytes to maintain the proper balance of salts and sugars; and blood products to replace blood loss. Discontinuing ECMO requires a surgical procedure to remove the tubes. Multiple tests are usually done prior to the discontinuation of ECMO therapy to confirm that your heart and lungs are ready. Once the ECMO cannulas are removed, the vessels will need to be repaired. This can be done either at the bedside or in the operating room. The doctor will use small stitches to close the spot where the tubes were placed. You will be asleep and monitored for this process. Even though you are off the ECMO, you may still need to be on a ventilator. 上了ECMO之后，患者可能會被給予某些藥物，包括：肝素用來預防血栓；抗生素用來預防感染；鎮(zhèn)靜劑用來減少活動、改善睡眠；利尿劑用來幫助腎臟排出液體；電解質(zhì)用來維持鹽和糖的平衡；血液制品補充失血。終止ECMO需要通過手術移除插管。在停止ECMO治療之前，通常會進行多次測試，以確保心臟和肺已經(jīng)準備充分。一旦ECMO管被拔除，血管則需修復，此時醫(yī)生將用小針縫合置換部位。在這過程中，患者將處于睡眠狀態(tài)，并被全程監(jiān)護。這些可在床邊或者手術室里完成。即使患者撤離了ECMO，仍然需要依靠呼吸機維持一段時間。 Risks ECMO does carry risks including: ?Bleeding, due to the medication that's given to prevent blood from clotting in the tubing. ?Infection at the sites where the tubes enter the body. ?Transfusion problems, since a person on ECMO is given blood products. ?Small clots or air bubbles forming in the tubing. ?Increased chance of stroke. 【風險】 ECMO存在的風險包括： ?由抗凝劑引起的出血。 ?置管部位出現(xiàn)感染。 ?由于輸注血液制品而出現(xiàn)的輸血問題。 ?管內(nèi)形成的小凝塊或氣泡。 ?中風的幾率增加。 【language points】 1．sedate /s??de?t/adj.安靜的；鎮(zhèn)靜的； vt.使鎮(zhèn)靜；給…服鎮(zhèn)靜劑 Sedative/?sed?t?v/ n.鎮(zhèn)靜劑，止痛藥 adj.鎮(zhèn)靜的，鎮(zhèn)定的，止痛的； sedation /s??de??n/ n.（尤指服用鎮(zhèn)靜劑而進入的）休息狀態(tài)，睡眠狀態(tài)； 2．a(chǎn)nti-coagulant 抗凝劑 Anti-前綴，“抗” eg. Antibody抗體 Coagulation 凝固 3．a(chǎn)ntibiotics /??nt?ba?'?t?ks/n.抗生素 Bio-(life,living) eg.Biopsy 活檢 4．Diuretic /?da?ju?ret?k/ n.利尿劑 Ur/o-；urino-（urine） eg.uremia /j?'ri:m??/尿毒癥 5．Minimize最小化 Maximize最大化 6．Ventilator/?vent?le?t?(r)/ 呼吸機 7．respiratory therapists 呼吸治療師 8．nasal-gastric tube鼻胃管 Nas/o-（nose） eg. Nasal/?ne?zl/ cavity 鼻腔 Gastr/o-（stomach）eg.Gastric/?g?str?k/ 胃的 gastrointestinal（GI）胃腸的 9．Heparin/'hep?r?n/肝素 Hepat/o-（liver） eg.Hepatitis 肝炎 -in，-ins（a substance）eg.Insulin 胰島素 10．Electrolyte/??lektr?la?t/ n.電解質(zhì) 11．Discontinuing終止 12．Stitch/st?t?/ n.針 vt.縫 (英文資料來源：cardiac.surgery.ucsf.edu；中文為講者自譯，圖片來源于網(wǎng)絡。) Bgm-keep holding on 撰稿講解：福建醫(yī)科大學 淑鉉鉉鉉