体外膜肺氧合在终末期心脏病围手术期严重心力衰竭中的应用  

Clinical application of extracorporeal membrane oxygenation for severe heart failure during peri-operative period of end-stage cardiopathy

作　　者：邱志兵[1] 肖立琼[1] 陈鑫[1] 石开虎[1] 徐明[1] 蒋英硕[1] 汪黎明[1] 杨婷[1] 张扬波[1] 

机构地区：[1]南京医科大学附属南京第一医院,南京市心血管病医院心血管外科,江苏210006

出　　处：《中国危重病急救医学》2010年第11期696-698,共3页Chinese Critical Care Medicine

基　　金：江苏省社会发展基金资助项目（BS2006013）

摘　　要：目的 观察体外膜肺氧合（ECMO）对终末期心脏病围手术期心力衰竭患者的治疗效果,总结临床经验.方法 选择本院2007年6月至2010年7月6例终末期心脏病围手术期心力衰竭行ECMO支持治疗的患者,观察ECMO期间患者的血流动力学及转归情况.结果 ECMO支持时间为23～168 h,平均78 h;患者的血流动力学明显改善[平均动脉压（MAP,mm Hg,1 mm Hg=0.133 kPa）：78.13±8.01比47.75±5.21,中心静脉压（mm Hg）：11.03±3.21比19.36±4.51,心排血量（L/min）：4.93±1.01比3.50±0.81,心排血指数（L·min-1·m-2）：2.71±0.51比1.91±0.40,肺动脉楔压（mm Hg）：12.72±6.52比20.22±6.91,静脉血氧饱和度：0.66±0.13比0.54±0.07],正性肌力药物使用量也显著减少[多巴胺（μg·kg-1·min-1）：5.05±0.85比14.20±5.05,肾上腺素（μg·kg-1·min-1）：0.05±0.01比0.24±0.04,均P＜0.05].6例患者均顺利脱机.3例康复出院,出院率50%;3例脱机后因多器官功能衰竭（MOF）死亡.主要并发症为出血、弥散性血管内凝血、感染、栓塞.结论 ECMO可对终末期心脏病围手术期严重心力衰竭患者提供有效的支持治疗,但需正确掌握适应证,合理选择患者.Objective To summarize the clinical effect and experience of extracorporeal membrane oxygenation （ECMO） support for severe heart failure during peri-operative period of end-stage cardiopathy.Methods From June 2007 to July 2010,6 patients with severe heart failure during peri-operative period of end-stage cardiopathy received ECMO support.The changes in the hemodynamics and outcome of the patients during the use of ECMO were investigated.Results The duration of ECMO assistance ranged from 23 to 168 hours with a mean of 78 hours.The hemodynamics after using ECMO was much improved than before ECMO[mean arterial pressure （mm Hg, 1 mm Hg=0.133 kPa）： 78.13±8.01 vs.47.75±5.21,central venous pressure （mm Hg）： 11.03±3.21 vs.19.36±4.51, cardiac output （L/min）： 4.93±1.01 vs.3.50± 0.81, cardiac index （L · min-1 · m-2）： 2.71 ± 0.51 vs.1.91 ± 0.40, pulmonary artery wedge pressure （mm Hg）： 12.72 ± 6.52 vs.20.22 ± 6.91, venous oxygen saturation： 0.66 ± 0.13 vs.0.54 ±0.07], and the amount of using inotropic drug was significantly reduced compared with that before ECMO [dopamine（μg · kg-1 · min-1）： 5.05 ± 0.85 vs.14.20 ± 5.05, epinephrine （μg · kg-1 · min-1）： 0.05 ±0.01 vs.0.24±0.04, all P＜0.05].All patients were successfully weaned from ECMO.After weaning,3 patients recovered and discharged, and the hospital discharge rate was 50%, while 3 patients died of multiple organ failure （MOF）.Major complication was bleeding, disseminated inravascular coagulation,infection,embolism.Conclusion ECMO is an important extracorporeal method to support life.ECMO is an effective measure of treatment for end-stage cardiopathy patients with peri-operative severe heart failure.It is important to properly select patients for ECMO.

关 键 词：体外膜肺氧合 终末期心脏病 心力衰竭 

分 类 号：R686[医药卫生—骨科学]