体外膜肺氧合治疗用于心肺复苏的临床研究  

Clinical experience of extracorporeal membrane oxygenation resuscitation in cardiac arrest patients

作　　者：于坤[1] 龙村[1] 宋云虎[2] 孙寒松[2] 李景文[1] 胡盛寿[2] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院体外循环科,北京100037 [2]中国医学科学院中国协和医科大学阜外心血管病医院心外科,北京100037

出　　处：《中国急救医学》2006年第12期911-914,共4页Chinese Journal of Critical Care Medicine

基　　金：北京市科技计划项目(No.H030930020130)

摘　　要：目的总结体外膜肺氧合(ECMO)治疗对于常规心肺复苏(CPR)困难患者的临床治疗经验。方法自2005 -09～2006-05我院进行ECMO治疗37例患者,其中11例心脏骤停后实施电除颤和心脏按压等CPR措施无效或自主循环恢复后持续低心排而行ECMO循环辅助。结果8例顺利停机,6例存活恢复出院,其中2例行心脏移植后康复出院。3例不能顺利撤机者在ECMO辅助期间由于循环功能恶化,最终因多器官功能衰竭死亡。顺利撤机和存活出院的患者治疗前乳酸水平较低,ECMO治疗后乳酸清除率较快(P＜0．05)。ECMO期间出现的并发症包括出血、神经精神系统异常、肢体缺血坏死和多脏器功能不全。4例患者因膜肺出现血浆渗漏而更换膜肺。结论ECMO可为危重心脏病患者心脏骤停后复苏困难时提供心肺功能支持,提高危重心脏病患者CPR的存活率。CPR后动脉血乳酸值和ECMO治疗后乳酸清除率可以预测患者预后。Objective To sum up clinical experience of extracorporeal membrane oxygenation （ECMO） treatment for the patients with cardiopulmonary resuscitation（ CPR ）. Methods 37 cases who underwent ECMO treatment from Sep. 2005 to May 2006 in our hospital were studied retrospectively. 11 cases with cardiac arrest accepted CPR before ECMO, and we reviewed the data of 11 CPR patients. Candidates for ECMO resuscitation were the patients who didn＇t response to CPR or returned to spontaneous circulation with persistent heart failure and needed ECMO support urgently after CPR. Results 8 eases were successfully weaned from ECMO. 6 cases survived and discharged at last , but 2 cases received heart transplantation. In the patients weaned successfully and survived, the blood lactate level was lower before ECMO treatment, and the lactate clearance rate was quicker. The complications during ECMO included bleeding, renal failure, neurological complications, infection and MODS. Conclusion ECMO can improve survival rate and the prognosis of patients with critical heart disease. The lactate level after CPR and the clearance rate after ECMO support can predict the prognosis of patients.

关 键 词：体外膜肺氧合 心脏骤停 心肺复苏 

分 类 号：R459.7[医药卫生—急诊医学]