应用体外膜肺氧合辅助治疗成人爆发性心肌炎的疗效观察  

The study of assistant therapeutic efficacy of ECMO on adult patients with fulminant myocarditis

作　　者：唐素美 侯新蕊[1] 胡鑫[1] 王兴萍[1] 任晶晶[1] 王玥 Tang Sumei;Hou Xinrui;Hu Xin;Wang Xinping;Ren Jingjing;Wang Yue(Cardiovascular Internal Medicine,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院心血管内科,北京100853

出　　处：《北京医学》2018年第11期1019-1021,共3页Beijing Medical Journal

摘　　要：目的探讨成人爆发性心肌炎(fulminant myocarditis,FM)患者应用体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)进行治疗的临床疗效。方法选取2014年2月至2016年2月解放军总医院收治的行ECMO辅助治疗的爆发性心肌炎成年患者34例,观察患者的生存情况;检测ECMO辅助前后心肌肌钙蛋白I(cardiac tropo-nin, cTnI)、脑尿钠肽(brain natriuretic peptide, BNP)及肌酸激酶同工酶(creatine kinase isoenzyme, CK-MB)水平变化;记录机械通气时间及并发症发生情况。结果患者存活29例,最终院内存活率为85.29%(29/34),ECMO辅助时间为(73.1±8.9)h,机械通气时间为(112.4±20.8)h,经过治疗后,存活患者的c TnI、BNP及CK-MB水平均低于治疗前,差异有统计学意义(P <0.05);并发症情况为出血2例(6.90%),氧合器血浆渗漏1例(3.45%),肺部感染2例(6.90%),下肢血栓3例(10.34%)。结论成人FM患者行ECMO辅助治疗的效果显著,可使机体的组织灌注得到有效改善,从而降低并发症发生率,值得在临床上推广应用。Objective To discuss the clinical efficacy of adult patients with fulminant myocarditis(FM) using extracorporeal membrane oxygenation(ECMO) for treatment. Methods Thirty-four adult cases of FM in Chinese PLA General Hospital from February 2014 to February 2016 performed the ECMO adjuvant treatment were selected. The levels of cardiac troponin I(cTnI), brain natriuretic peptid(BNP) and creatine kinase isoenzyme(CK-MB) before and after ECMO support were observed. The survival of patients, and mechanical ventilation time and complications were also recorded. Results The survival rate was 85.29%, the ECMO support time was(73.1 ± 8.9) h, and mechanical ventilation time was(112.4±20.8) h. After treatment, the levels of cTnI, BNP and CK-MB of survival patients were lower than those before treatment, the difference was statistically significant(P < 0.05). Complications were observed for hemorrhage in 2 cases(6.90%), oxygenator plasma leakage in 1 case(3.45%), pulmonary infection in 2 cases(6.90%), lower extremities thrombosis in 3 patients(10.34%). Conclusions The effect of ECMO on adult patients with FM is remarkable. It can be used to effectively improve the patient’s tissue perfusion, so as to reduce the incidence of complications, and is worthy of popularization and application in clinic.

关 键 词：爆发性心肌炎 体外膜肺氧合 效果 

分 类 号：R542.21[医药卫生—心血管疾病]