心血管术后体外膜肺氧合治疗58例临床分析  

Clinical analysis of 58 patients with extracorporeal membrane oxygenation after cardiovascular surgeries

作　　者：杜宇[1] 郑晓梅[1] 王玲凤[1] 张旭[1] 柳克祥[1] 孙卫红[1] 

机构地区：[1]吉林大学第二医院心血管外科,吉林长春130041

出　　处：《中国医药导报》2015年第32期69-73,共5页China Medical Herald

基　　金：国家"十二五"科技支撑计划项目(2011BAI11B21)

摘　　要：目的探讨应用体外膜肺氧合（ECMO）患者的治疗及相关并发症防治的经验与方法。方法选择2009年11月~2015年7月心血管术后患者58例,这些患者因心功能下降,无法维持有效循环或无法脱离体外循环,而实施体外膜肺氧合。总结并分析这些患者的相关临床资料及体外膜肺氧合的应用指征与治疗方案。结果本组病例ECMO脱机率为52.45%,出院率为32.67%,ECMO转流期间气管插管拔除率为37.93%。并发症发生率为75.86%,其中机体并发症包括出血和渗血16例、感染9例、肾功能不全8例、高胆红素血症8例、血小板减少2例、肢体远端缺陷1例、继发性弥漫性血管内凝血（DIC）1例;机械性并发症为氧合器及管路血栓9例、氧合器渗漏1例。结论在ECMO治疗期间应注重患者的生理及心理状态,同时加强对相关机体并发症及机械并发症的防治,对于提高ECMO的成功率有着重要的意义。Objective To discuss experiences and technology of treatments of extracorporeal membrane oxygenation（ECMO） patients underwent cardiovascular surgeries, and prevent the complications during ECMO. Methods From November 2009 to July 2015, 58 patients were performed ECMO after cardiovascular surgeries, because their decreased cardiac function, being unable to maintain effective circulation or separated from extracorporeal circulation. The relevant clinical data of 58 patients, the indications for application and treatment programmes of ECMO were summarized and analyzed in this study. Results The rate of stopped ECMO safely was 52.45%, and the discharge rate was 32.67%.The rate without ventilator assistance during ECMO was 37.93%, and the rate occurring complications was 75.86%. Organism complications included 16 cases with bleeding and oozy blood, 9 cases with infections, 8 cases with renal insufficiency, 8 cases with hyperbilirubinemia, 2 cases with thrombocytopenia, 1 case with distal limb defects, and 1 case with secondary disseminated intravascular coagulation（DIC）. Mechanical complications included 9 cases with thrombosis in oxygen mixer and piping and 1 case with leakage of oxygen mixer. Conclusion During ECMO treatment, the physiological and psychological demands of patients should be paid attention to. Simultaneously, to strengthen the prevention and treatment of organism and mechanical complications of ECMO is important to improve the success rate of ECMO.

关 键 词：体外膜肺氧合 并发症 心血管手术 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]