总结肺移植术中体外膜肺氧合(ECMO)的插管方式及应用策略。

回顾性分析广州医科大学附属第一医院2016年1月至2018年7月完成的107例肺移植中，31例术中应用ECMO辅助的受者资料，其中双肺移植20例，单肺移植11例。术中ECMO辅助方式为静脉-动脉(VA)-ECMO 30例，VVA-ECMO 1例。

31例术中ECMO辅助指征：不能耐受单肺通气(术前及术中移植一侧肺后)14例，肺动脉高压7例，术中血流动力学不稳定3例，术中上半身缺氧1例，术前VV-ECMO过渡6例。插管方式：中央插管20例，股静脉-股动脉插管5例，股静脉-腋动脉插管5例，股静脉-颈内静脉-升主动脉插管1例。术后30 d内2例受者因多器官功能衰竭死亡。不同插管方式中，中央插管无明显并发症；股静脉-股动脉插管出血2例，下肢缺血3例，术中上半身缺氧1例，术后切口愈合不良2例；股静脉-腋动脉插管出血1例。5例受者因术后移植肺功能未达标，ECMO延续至术后早期。

肺移植术中ECMO是有效的呼吸循环辅助方式，腋动脉插管有助于避免肢体远端缺血、血栓形成及上半身灌注不足等并发症。

To summarize the mode of intubation and application strategy of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation.

One hundred and seven patients received lung transplantation at the First Affiliated Hospital of Guangzhou Medical University from January 2016 to July 2018, 31 cases of them received ECMO during transplantation and their clinical data were retrospectively analyzed, 20 recipients received double lung transplantation, and 11 recipients received single lung transplantation. Thirty recipients received veno-arterial-ECMO and 1 recipient received veno-veno-arterial-ECMO.

The indication for ECMO during transplantation included 14 cases who couldn′t tolerate one-lung ventilation, 7 of pulmonary arterial hypertension, 3 of intraoperative hemodynamic instability, 1 of intraoperative upper body hypoxia, and 6 of preoperative veno-arterial-ECMO transition. The mode of intubation included 20 cases of central intubation, 5 of femoral vein-femoral artery intubation, 5 of femoral vein-axillary artery intubation, and 1 of femoral vein-jugular vein-ascending aorta intubation. Two patients died of multiple organ failure during 30 days after transplantation. Recipients with central intubation had no obvious complication. Two recipients had bleeding, 1 had intraoperative upper body hypoxia, and 2 had poor wound healing among recipients undergone femoral vein-femoral artery intubation. One recipient underwent bleeding among recipients with femoral vein-axillary artery intubation.The use of ECMO continued into the early period of postoperation in 5 recipients because the function of lung failed to meet the standards.

Intraoperative ECMO use is an important auxiliary way for respiration and circulation, and axillary artery intubation can avoid the complications included distal limb ischemia, thrombosis and upper body hypoperfusion.