ECMO-MAQUET原厂培训课件

ECMO本世纪的机遇和挑战*Thisisthestandardtitleslidewitha“corporate”imagemotif.Theimageismerelyaplaceholder.Theimagecanbechangedusing“View–Master–SlideMaster”.Theimagehastobeentirelywithintheframe.*©MAQUET* What?Why?When? Where?Who?How? ECMOSYSTEM Case EXTRACORPOREALLIFESUPPORT©MAQUET*ECMO是什么ECMO原理 体外膜肺氧合(Extracorporealmembraneoxygenation)技术： 是一种持续体外生命支持手段， 将体内的静脉血引出体外，经过特殊材质人工心肺旁路氧合后注入病人动脉或静脉系统，维持人体脏器组织氧合血供。 通过体外设备较长时间全部或部分代替心肺功能，使心脏、肺脏得以充分休息，以争取心脏、肺脏病变治愈及功能恢复的时间。 急性、潜在可复性、威胁生命的、对传统治疗无效的呼吸、循环衰竭是ECMO的指征。ECMO的原理——对呼吸系统的作用支持:改善氧合和CO2清除休息:减轻呼吸机、高氧引起的肺损伤对循环系统的作用维持有效循环改善组织灌注减少心脏做功减少血管活性药物使用* 作用：心肺支持 过程：用心向死神要生命ECLS:extracorporeallifesupport 1950s的体外生命支持难以维持数小时以上 体外模式氧合(ECMO) 改进体外循环(CPB) 1971Hill第一例ECMO治疗ARDS 1975Bartlett第一例ECMO成功治疗新生儿NRDS*ECMOiswell-knownandacommontermforintensivist,andECLSistheanotherformaltermforECMOrecently.Itisderivedandmodifiedfromcardiopulmonarybypass.Twogiants,Dr.GibbonandDennis,mustbereminded.TheydevotedthemselvesalotintheapplicationofCPBandECMOdevelopment.TheECMOusuallybecamealethalresultwhenitranmorethanafewhours. 首例成功应用长时间生命支持是在1971年由JDonaldHill及其团队完成。患者是1位患成人呼吸窘迫综合征（ARDS）的青年男性新的开始 1975年，美国密西根大学医学院Bartlett等成功对一名因胎粪吸入综合症导致呼吸衰竭的女性弃婴施行ECMO抢救成功。 兴奋的医护人员将该无名婴儿命名为Esperanza（希望）该患者目前已经是一名健康快乐的母亲ECMO模式VV–ECMO、VA–ECMOVV-ECMO气体交换、循环途径、心脏负荷的变化？VV-ECMO对呼吸的作用全身炎性反应支持:休息: 有效气体交换高氧损伤机械损伤*VA-ECMO 气体交换、循环途径、心脏负荷的变化？VA-ECMO对循环的作用全身炎性反应支持:心脏: 维持有效循环帮助心脏维持有效循环减少药物应用**©MAQUET*VVA-ECMOEXTRACORPOREALLIFESUPPORT心肺功能均严重受损O2Saturation*Veno-arterialECMO:maybeappliedfortheshorttermmanagementofcardio-respiratoryfailureorcardiacfailurerefractorytoinotropicandIABPsupportwhereuseofaventricularassistdevice(VAD)isdeemedinappropriate.Itmaybeappliedviacentralorperipheralcannulation.*©MAQUET*VVA-ECMOEXTRACORPOREALLIFESUPPORT心肺功能均严重受损O2Saturation*Veno-arterialECMO:maybeappliedfortheshorttermmanagementofcardio-respiratoryfailureorcardiacfailurerefractorytoinotropicandIABPsupportwhereuseofaventricularassistdevice(VAD)isdeemedinappropriate.Itmaybeappliedviacentralorperipheralcannulation.ECMO适应证、禁忌证 ECMO的应用范围：常规治疗效果不理想，病人心肺部病变能够逆转，或有相应的后续治疗措施ICU/急诊 ARDS 肺水肿/渗出性病变 肺移植前后 急性肺栓塞 呼吸道损伤 心肌炎 创伤 中毒 危重患者转运 安慰适应证心胸外科 心梗 术后心肌顿抑/低心排 心脏移植前后 气道肿瘤或手术 邻近组织器官病变 肺移植前后 器官供体ECMO意义 ECMO使严重的心功能、呼吸功能衰竭不成为病人的直接死因 为病人争得了较充分的改进治疗的时间 对严重的以累及心肺功能为主的创伤、中毒、感染以及危重的手术病人提供了部分保障ChECLS数据库信息需要注意 病变不能逆转或无相应治疗措施 显著出血倾向（？） 中枢神经系统损害 晚期恶性肿瘤*©MAQUET*ECLS治疗在哪里进行?EXTRACORPOREALLIFESUPPORT©MAQUET*Useaslittletextaspossible(keywordsinsteadofbodytext)Thetextshouldalwaysbeleftjustified,nevercenteredorrightjustifiedAnimationsshouldonlybeusedwhereappropriateTheheadlineisalwaystobesetincapitalletters*©MAQUET*ICU、急诊:EXTRACORPOREALLIFESUPPORT©MAQUET*Imagescanbeformattedusingthefunction“Cut”(drawingtoolbar).Reductionoftheresolutionoftheentirepresentationusingthefunction“Compressimages”(drawingtoolbar).Wherepossible,however,theresolutionshouldbereducedbeforetheimageisinserted.*©MAQUET*手术室、导管室EXTRACORPOREALLIFESUPPORT©MAQUET*Imagescanbeformattedusingthefunction“Cut”(drawingtoolbar).Reductionoftheresolutionoftheentirepresentationusingthefunction“Compressimages”(drawingtoolbar).Wherepossible,however,theresolutionshouldbereducedbeforetheimageisinserted.*©MAQUET*急救转运EXTRACORPOREALLIFESUPPORT©MAQUET*Imagescanbeformattedusingthefunction“Cut”(drawingtoolbar).Reductionoftheresolutionoftheentirepresentationusingthefunction“Compressimages”(drawingtoolbar).Wherepossible,however,theresolutionshouldbereducedbeforetheimageisinserted.*©MAQUET*ECLS治疗团队 人员组成 业务培训 资料收集EXTRACORPOREALLIFESUPPORT©MAQUET*Imagescanbeformattedusingthefunction“Cut”(drawingtoolbar).Toensurethattwoimageshavethesamewidthorheight,thesamewidth/heightmaybesetusing“Formatgraphic”(rightmouseclickonimage,“Formatgraphic”,“Size”).Reductionoftheresolutionoftheentirepresentationusingthefunction“Compressimages”(drawingtoolbar).Wherepossible,however,theresolutionshouldbereducedbeforetheimageisinserted.停机放弃继续转流心肺移植ECLS结果*ECMO是一项工程病例一 呼吸支持ECMO172天后成功撤离 患者：女，28岁 甲流2010-102010-32010-52010-9病例二 循环支持患儿,男,11岁,“发热4天,胸闷1天”转入杭州市一院。诊断:暴发性心肌炎入科后第二天，心源性休克，血压70/30mmHg左右，四肢冷,尿量少心电监护：多源多型室性心律，ST段抬高,心超：EF30％ECMO第六天EKG,停机前,EF42~45%,整个ECMO期间(140小时)心跳骤停三次(ECMO1h,第1天晨,2天上午)ECMO脱离后11天出院病例三 器官移植心肌病严重心衰心脏移植供心动脉粥样硬化ECMO渗血严重，大量输血输液导致心肺功能恶化。少尿IABP及ECMO行CABG心肌收缩仍差CPB下二次心脏移植，暂停ECMO术后呼吸功能未恢复再次进行ECMO心肺功能改善停止ECMOPLS器材 设备 耗材 药品 设备：离心泵、空氧混合器及气源、变温水箱、ACT监测仪及ACT检测管、血气仪、连续血氧饱和度监测仪及连接玻管、转运车等 耗材：PLS套包及其支架、动静脉插管等 药品：预充液、肝素离心泵(MAQUET) *离心泵示意图变温水箱HU35 对患者血液进行变温加水口水循环接口备用接口固定架水位显示实际水温报警信息设定水温33-39℃电源开关水流显示水温调节键性能检测键消音键*©MAQUET*氧合器 代替患者肺功能 气血水三通路 气体交换 变温©MAQUET插管(注册证申请中)09-03-25©MAQUET*THANKYOU!Yoursalescontact:MAQUET(Shanghai)MedicalEquipmentCo.,Ltd. No.3,Lane128,LinHongRoad,ChangningDistrict,Shanghai，P.R.China200335 Phone：+86(0)2161973999Fax：+86(0)2162280238ServiceHotline8008200207©MAQUET*Thisisthefinalslide.Thisslidecanbeusedforcontactdetails.*Thisisthestandardtitleslidewitha“corporate”imagemotif.Theimageismerelyaplaceholder.Theimagecanbechangedusing“View–Master–SlideMaster”.Theimagehastobeentirelywithintheframe.*ECMO的原理——对呼吸系统的作用支持:改善氧合和CO2清除休息:减轻呼吸机、高氧引起的肺损伤对循环系统的作用维持有效循环改善组织灌注减少心脏做功减少血管活性药物使用**ECMOiswell-knownandacommontermforintensivist,andECLSistheanotherformaltermforECMOrecently.Itisderivedandmodifiedfromcardiopulmonarybypass.Twogiants,Dr.GibbonandDennis,mustbereminded.TheydevotedthemselvesalotintheapplicationofCPBandECMOdevelopment.TheECMOusuallybecamealethalresultwhenitranmorethanafewhours.***Veno-arterialECMO:maybeappliedfortheshorttermmanagementofcardio-respiratoryfailureorcardiacfailurerefractorytoinotropicandIABPsupportwhereuseofaventricularassistdevice(VAD)isdeemedinappropriate.Itmaybeappliedviacentralorperipheralcannulation.*Veno-arterialECMO:maybeappliedfortheshorttermmanagementofcardio-respiratoryfailureorcardiacfailurerefractorytoinotropicandIABPsupportwhereuseofaventricularassistdevice(VAD)isdeemedinappropriate.Itmaybeappliedviacentralorperipheralcannulation.*Useaslittletextaspossible(keywordsinsteadofbodytext)Thetextshouldalwaysbeleftjustified,nevercenteredorrightjustifiedAnimationsshouldonlybeusedwhereappropriateTheheadlineisalwaystobesetincapitalletters*Imagescanbeformattedusingthefunction“Cut”(drawingtoolbar).Reductionoftheresolutionoftheentirepresentationusingthefunction“Compressimages”(drawingtoolbar).Wherepossible,however,theresolutionshouldbereducedbeforetheimageisinserted.*Imagescanbeformattedusingthefunction“Cut”(drawingtoolbar).Reductionoftheresolutionoftheentirepresentationusingthefunction“Compressimages”(drawingtoolbar).Wherepossible,however,theresolutionshouldbereducedbeforetheimageisinserted.*Imagescanbeformattedusingthefunction“Cut”(drawingtoolbar).Reductionoftheresolutionoftheentirepresentationusingthefunction“Compressimages”(drawingtoolbar).Wherepossible,however,theresolutionshouldbereducedbeforetheimageisinserted.*Imagescanbeformattedusingthefunction“Cut”(drawingtoolbar).Toensurethattwoimageshavethesamewidthorheight,thesamewidth/heightmaybesetusing“Formatgraphic”(rightmouseclickonimage,“Formatgraphic”,“Size”).Reductionoftheresolutionoftheentirepresentationusingthefunction“Compressimages”(drawingtoolbar).Wherepossible,however,theresolutionshouldbereducedbeforetheimageisinserted.***Thisisthefinalslide.Thisslidecanbeusedforcontactdetails.