体外膜式氧合在冠心病外科治疗中的临床应用  

The application of extracorporeal membrane oxygenation for surgical treatment of coronary artery disease

作　　者：闫晓蕾[1] 李群 于洋[3] 侯晓彤[4] 杨勇[1] 万久贺[1] 贾明[1] 孟旭[3] 贾世杰[1] 

机构地区：[1]首都医科大学附属北京安贞医院监护室,100029 [2]清华大学第一附属医院心内科 [3]首都医科大学附属北京安贞医院心外科,100029 [4]首都医科大学附属北京安贞医院体外循环室,100029

出　　处：《中华外科杂志》2007年第24期1714-1716,共3页Chinese Journal of Surgery

摘　　要：目的探讨冠状动脉粥样硬化性心脏病(冠心病)心脏手术后应用体外膜式氧合(ECMO)进行支持治疗的效果。方法 2004年6月至2006年11月,对16例冠心病心脏手术后需要心肺支持的患者进行 ECMO 辅助治疗。全组患者男14例,女2例,平均年龄(58±11)岁。体外循环下手术13例,非体外循环手术3例。记录术后 ECMO 辅助时间、监护室停留时间、并发症及转归等。结果 ECMO 平均辅助时间51 h。监护室平均停留时间5 d。13例患者顺利撤除 ECMO,脱机率为81.3%;10例生存出院,出院生存率为62.5%。主要并发症有出血(18.8%)、感染(37.5%)、肾功能不全(25%)及下肢缺血(18.8%)等。结论 ECMO 辅助能有效治疗冠心病心脏手术后发生的心功能障碍。Objective To summarize the results and experiences on extracorporeal membrane oxygenation （ECMO） for post-cardiac surgery of coronary artery disease. Methods From June 2004 to November 2006, sixteen patients with the mean age of （ 58±11） years old undergoing cardiac surgical procedures were placed on ECMO using a heparin-bonded circuit. Forteen patients were male and two patients were female. Thirteen patients underwent on pump coronary artery bypass surgery （CABG） and three patients underwent off-pump coronary artery bypass grafting. The duration of ECMO support, stay of intensive care unit （ICU stay）, complications and turnovers were recorded. Results The mean duration of ECMO support was 51 hours, and the mean duration of ICU stay was 5 days. Thirteen patients （81.3%） were successfully weaned form ECMO, ten patients （ 62.5% ） were discharged from hospital. The main complications were bleeding, infection, renal failure and ischemia of the lower limbs with the incidence of 18. 8% , 37.5% , 25% and 18.8% respectively. Conclusion ECMO is an acceptable technique for shortterm treatment of refractory low cardiac output after cardiac surgery of coronary artery disease.

关 键 词：冠状动脉疾病 心脏外科手术 体外膜式氧合 

分 类 号：R654.2[医药卫生—外科学]