体外膜肺氧合治疗成人心脏术后心源性休克的临床经验及生命质量分析  

Clinical experience with adults receiving extracorporeal membrane oxygenation for cardiogenic shock and quality of life in survivals

作　　者：王坚刚[1] 孟旭[1] 韩杰[1] 贾一新[1] 曾文[1] 许春雷[1] 张海波[1] 高峰[1] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院心外科,100029

出　　处：《中华医学杂志》2010年第5期310-314,共5页National Medical Journal of China

摘　　要：目的总结成人心脏术后心源性休克患者应用体外膜肺氧合（ECMO）治疗的临床经验，对生存者进行生命质量分析。方法2004年1月至2008年5月北京安贞医院心脏外科62例心源性休克患者应用ECMO支持。其中男32例、女30例，年龄16～73（51±15）岁。术前纽约心脏学会（NYHA）心功能分级Ⅲ～Ⅳ级36例。瓣膜手术39例，冠状动脉旁路移植13例，瓣膜手术合并冠状动脉旁路移植4例，心脏移植4例，其他手术2例。随访平均（2．3±1．5）年，利用SF-36量表进行生命质量分析。结果辅助时间36～135h，平均（61±37）h。40例患者顺利撤除ECMO（脱机率64．5％），其中34例患者康复出院，总出院存活率54．8％。主要死亡原因是多器官功能衰竭。Logistic回归分析得出ECMO前乳酸峰值≥12mmol／L是死亡的危险因素（P〈0．05）。ECMO生存者的活力和心理功能评分显著低于其他心脏手术后的患者（P〈0．05）。其他评分ECMO生存者与其他心脏手术后的患者均低于正常人，差异有统计学意义（P〈0．05）。结论ECMO对于成人心脏术后心源性休克是一种有效的支持手段。严格掌握适应证及时机，严密防治并发症是进一步提高ECMO疗效的关键。ECMO生存者在活力和心理功能的康复有待提高。Objective To review the experience with extracorporeal membrane oxygenation （ECMO） in adult postcardiotomy eadiogenie shock and evaluate quality of life （QOL） in survivals. Methods During 4 years 62 of 12,644 patients （0. 49% ） undergoing cardiac surgery （ valve procedures, n = 39; coronary artery bypass grafting, n = 13; coronary artery bypass grafting plus valve procedures, n = 4 ; heart transplantation, n = 4, and total aortic arch replacement, n = 2 ） required temporary postoperative ECMO support. At follow-up （mean 2. 3 ± 1.5 years, 100% complete） , 32 were still alive and answered the Short-Form 36 Health Survey QOL questionnaire. Results Mean duration of ECMO support was 61 ± 37 hors. Forty patients （64. 5% ） were successfully weaned from ECMO. Thirty-four patients （54. 8% ） were discharged from hospital after 44. 3 ± 17. 6 days. The in-hospital mortality was 45.2%. The main cause of death was multiple organ failure. The postoperative peak lactate levels ≥12 mmol/L before ECMO initiation was a risk factor of in-hospital death. Mean QOL scores between the ECMO survivors and other patients after cardiac surgery without ECMO support showed no significant difference, except that the vitality and mental health were significant lower in the ECMO survivors （ P 〈 0. 05 ）. Both the ECMO survivors and the patients without ECMO support have significant lower QOL scores （except the vitality and mental health） relative to their respective Chinese population norms （P 〈 0. 05 ）. Conclusion ECMO offers sufficient cardiopulmonary support in adults. Early indication, reduced complication could improve results with increasing experience. However, ECMO survivors had lower physical and mental health that need to be recovered.

关 键 词：体外膜肺氧合 生存质量 SF-36 

分 类 号：R654.2[医药卫生—外科学]