体外膜肺氧合在心肺脑复苏中的应用  

Application of extracorporeal membrane oxygenation to cardiopulmonary cerebral resuscitation

作　　者：蒋崇慧[1] 黄子通[1] 谢钢[2] 李斌飞[2] 宁晔[2] 吴美英 郑伟华[2] 尹刚[2] 赵双彪[2] 

机构地区：[1]中山大学附属第二医院 [2]中山大学附属中山医院 [3]不详

出　　处：《中华急诊医学杂志》2008年第6期634-637,共4页Chinese Journal of Emergency Medicine

基　　金：广东省卫生厅自然科学基金资助项目（2003A056）;广东省社会发展领域科技计划项目（63119）

摘　　要：目的探讨体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）在心脏骤停患者中的治疗作用及应用价值。方法回顾分析2002年6月至2007年6月期间，本院急诊和重症监护室应用体外膜肺氧合（ECMO）治疗的心脏骤停15例患者，按照美国心脏学会《2005年心肺复苏和心血管急救国际指南》的标准诊治方案进行救治，同时行体外膜肺氧合（ECMO）治疗。采用治疗前后自身对照的方法，监测ECMO治疗前、ECMO治疗后10min、1h、6h、12h、24h，患者的心率、平均动脉压、中心静脉压（CVP）；并抽取桡动脉血检测动脉血氧分压、二氧化碳分压、血氧饱和度、酸碱度、动脉血乳酸含量等指标；统计数据以（-↑x±s）表示，采用SPSS10．0统计软件包进行t检验，以P〈0．05为差异具有统计学意义；同时就患者的神经性后遗症进行了观察和描述。结果平均动脉压在ECMO治疗后10min比ECMO治疗前明显升高（P〈0．01），ECMO治疗后1h比ECMO治疗后10min有所升高（P〈0．05）；CVP在ECMO治疗后10min比ECMO治疗前，ECMO治疗后1h比ECMO治疗后10min有所降低（P〈0．05）；经ECMO治疗后10min动脉血氧分压、血氧饱和度较ECMO治疗前明显上升（P〈0．01），pH明显升高（P〈0．01），动脉血乳酸含量明显降低（P〈0．01）。15例患者中，11例康复出院，其中5例完全康复，没有后遗症，2例有部分记忆障碍，无躯体后遗症；2例有精神障碍，2例有肢体偏瘫。结论ECMO治疗可辅助心脏维持有效的血液循环，明显改善低氧血症，为大脑提供稳定的氧合血灌流，对心肺脑复苏有利。Objective To investigate the effects and values of extracorporeal membrane oxygenation （ECMO） used in patients after cardiac arrest. Method During five years period from June 2002 to June 2007,fifteen cases taken for cardiopulmonary resuscitation were treated by using ECMO in the emergency department and ICU. All the measures for disgnosis and treatment were observed to the guidelines for cardiopulmonary resuscitation and emergency cardiovasculat care set by the American Heart Association in 2005, and ECMO was applied in addition. The study was a self-comparison trial. The biomarkers including heart rate （HR）, mean arterial pressure（MAP）, central venous pressure（CVP）, arterial partial oxygen pressure （PaO2）, arterial partial pressure of carbon dioxide （PCO2）, oxygen saturation （SaO2）, hydrogen power （PH）, and concentration of lactic acid were taken and assayed before and 10 min, 1 h,6 h,12 h,and 24 h after treatment. Differences between the results of measurements were analysed by t -test for matched pairs using SPSS version 10.0 software package. Neurological sequelae was also observed and described. Results Ten minutes after ECMO treatment, MAP rose dramatically （P 〈 0.01） and got to further higher level one hour later （ P 〈 0.05）. On the other hand, CVP dropped off 10 minutes after ECMO treatment and further lowered one hour later,and PaO2 and SaO2 were improved apparently （P 〈 0.01）, and pH was increased significantly （ P 〈 0.01 ）, while a derease in concentration of arterial LA of significantly （ P 〈 0.01 ）. Of the 15 cases, 11 patients got well, including completely recovered without sequelae in 5, memory disorders in 2 and hemipleggia in 2 patients. Conclusions ECMO provides effective blood flow to hearts, and therefore, improves oxygenation and oxygen consumption greatly. Moreover, it provides stable oxygenated blood to brain and therefore, it is a good approach to cardiopulmonary cerebral resuscitation.

关 键 词：心脏骤停 体外膜肺氧合 心肺脑复苏 

分 类 号：R459.7[医药卫生—急诊医学]