In vitro membrane pulmonary oxygenation successfully treated 2 cases of severe maternal

In vitro membrane pulmonary oxygenation (ECMO) plays an important role in the clinical critical treatment of internal surgery because it provides effective cardiopulmonary support and enables patients to pass the deadly risk periodWith the arrival of the two-child period, the number of critical and serious obstetric patients is gradually increasing, ECMO in obstetric rescue is also increasingly effective, Wuxi City People's Hospital since May 2018 with multidisciplinary assistance in the use of ECMO successfully treated two cases of extremely critical lying pregnant women, is reported below1 medical records summary
1After the mother 42 years old, had a caesarean section before 2013, abortion 5 times, this time due to repeated coughing, shortness of breath 14 years, aggravated 5 months on May 3, 2018 in Wuxi City People's Hospital thoracic surgery, admission to the hospital pregnant 21-3 weeks, the hospital heart ultrasound show: follow-up hole-type space interval defects (1.7 cm) Shunt, pulmonary artery pressure increase (126 mmHg), right atrium, right ventricle enlargement, three-tip valve moderate reflux; After this pregnancy, the patient refuses to terminate the pregnancy despite the dissuasion from the early pregnancyAdmission diagnosis: severe pulmonary arterial hypertension, room interval defect, heart function iii level, pregnancy 7 birth 1 pregnancy 21 plus 3 weeks; after admission multidisciplinary collaborative consultation room, remodurin venous micropump treatment and gradually adjusted to the appropriate dose, dexamietalyturin lung maturation, oxygen absorption, monitoring of vital signs and inlet fluid volume and other treatment, in pregnancy 27 and 5 weeks in the high flow of oxygen intake (95%) state, oxygen saturation can only be maintained at 0.82 to 0.88, and there is obvious chest tightness, asthma, after many discussions decided to first in the bureau of hemp sub-operative intrauterine lung implantation, and then in the whole line of uterine sub-section, two-sided uterine artery conjugation and two-sided uterine artery transport ligation, two-sided lacylates ligationThe operation went smoothly, hemorrhage 250 mL, transferred to intensive care, born a newborn 1150 g, Apgar score 8 to 9 points, in the neonatal department treatmentThe mother continued ECMO cardiopulmonary support, anti-inflammatory, pulmonary artery pressure and other treatment, after surgery 11 d due to poor heart function, ventricular fibrillation, vein-artery (V-A) ECMO difficult to withdrawAfter multidisciplinary discussion, in the whole hemp downstream external circulation under the front chest fracture chest incision space gap repair, double lung transplant, surgery smoothly, after surgery 5d V-A ECMO withdrawal machine, after surgery 83 d patients recovered well dischargedThe mother's follow-up to lung transplant was more than 9 months after the death due to a serious lung infection, the child is still alivecases 27 years of age, due to pregnancy 40 plus 5 weeks after the natural delivery of the hospital hemorrhage and a total hysterectomy in the local hospital, estimated blood loss of 5000 mL, less levitation white red blood 4400 mL, plasma 2400 mL, local hospital check hemoglobin 12.2 g/L Platelet count 22.2 x 109/L, clotted enzyme intheresavel time greater than 100 s, activated partial clotting active enzyme time 147.9 s, clotting enzyme time 27.6 s, pH6.9, blood potassium 2.6mmol/L, lactic acid greater than 20 mmol/LAfter surgery, vaginal bleeding, blood pressure dropped, cardiac arrest, after CPR to norepinephrine still drop maintenance on December 31, 2018 to my hospital intensive care unitAdmission: Postpartum hemorrhage, low blood volume shock, acute respiratory distress syndrome (ARDS), DIC, acute kidney injury, acute liver insufficiency, cprum resuscitation syndrome, blood electrolyte disorder, pregnancy 4 maternity 2 pregnancy 40 s 5 weeks, full hysterectomyAfter admission to the ventilator-assisted ventilation, active anti-shock, blood transfusion, correct edified blood function, anti-infection, acid correction and other treatments, due to low oxygenation index, the air channel suction pink foam sputum, vaginal continuous bleeding, ultrasonic abdominal fluid increase through multidisciplinary consultation and discussion, consider inglisal respiratory distress syndrome, abdominal cavity has active bleedingAfter admission to the hospital, the day after the whole hemp vein -venous (V-V) ECMO placement and caesarean section During the operation see a large amount of blood accumulation in the pelvic cavity about 3000 mL, the right uterine vein has active bleeding that is the right side of the uterine vein ligation and bilateral intralateral artery ligation, the operation is suspended less white blood cells 1600 mL, the virus inactivated plasma 400 mL, platelets 1 treatment volume After surgery, anti-shock, blood transfusion, blood transfusion platelet, liver protection, correction of clotting function, correction of acid-base balance and electrolyte disorders, anti-infection, blood purification and other treatments After 2 d ARDS symptoms improved to V-VECMO withdrawal, 4 d after the withdrawal of the ventilator, the patient's condition gradually improved After the operation 24d urine appeared, after surgery 34 d kidney function basically returned to normal and stopped hemodialysis, after surgery 64d patients recovered well discharged 2 discussion 2.1ECMO as an in vitro respiratory circulation support technology can effectively treat critically ill pregnant women because of heart disease patients prone to serious complications during pregnancy, is an important cause of maternal non-obstetric factors death, so patients with a history of heart disease, before pregnancy need to be clear whether surgery correction, not suitable for pregnancy should be strict contraception, not suitable for pregnancy once pregnancy should be terminated early, such as allowed to co-administer pregnancy with other disciplines The hospital case 1 patients, their senior age, congenital heart disease combined with severe pulmonary hypertension, regardless of family members and doctors to discourage, although the use of ECMO through the difficulties of childbirth, but the emergence of lung transplant after serious infection complications, poor outcome, should be taken as a warning In addition, ECMO can effectively treat ARDS in the ICU At present, ECMO applications focus on internal medicine and surgery, with the introduction of the two-child policy, there are senior, serious complications and a variety of internal surgery comorbidities of high-risk pregnant women, for critical and severe maternal need to be through multidisciplinary diagnosis and treatment (MDT), and even ECMO technology to save the lives of patients From the two cases of severe maternal disease in this paper, ECMO was used in the rescue process, and the effect was obtained For patients with dangerous amniotic paltry hypertension, ECMO technology can also be used, and some efficacy can be obtained 2.2ECMO technical features ECMO can be used as an active and effective treatment measure for clinically ineffective critically ill pregnant women, can provide effective cardiopulmonary assistance from days to weeks, place quickly and easily, and can provide 4 to 6 L/min blood flow Therefore, in recent years, ECMO has been used more and more widely in critically ill patients, especially in the fields of refractive cardiac shock, cardiac arrest, severe acute respiratory failure, high-risk transdermal coronary artery intervention therapy or cardiac surgery period auxiliary therapy, which has won time for the restoration of patients' cardiopulmonary function Depending on the blood return mode, ECMO is divided into vein-to-arterial in vitro membrane pulmonary oxygenation (VA-ECMO) and vein-to-veninial in vitro membrane pulmonary oxygenation (VV-ECMO), which has both circulatory and respiratory auxiliary effects, while the latter has only respiratory support At the same time, we also need to understand ECMO complications, including patient systomic complications (complications related to treatment, including surgical woundand and intubation site bleeding, embolism, end limb ischemia, hemolytic, abnormal nervous system function, renal insufficiency and infection, etc.) and ECMO mechanical system complications (complications related to ECMO lines, equipment, including oxygen ate, plasma leakage, circulatory rupture, drive pump and heat exchanger function abnormality) Therefore, the clinical management of ECMO should be done strictly references