体外膜肺氧合治疗难治性心原性休克的临床疗效及其影响因素  

The effect and factors associated with outcome of extracorporeal membrane oxygenation in refractory cardiogenic shock patients

作　　者：朱瑞秋[1] 刘长智[1] 卢剑海[1] 苏用鹏[1] 温树超 聂广杰[2] 胡允兆[3] 左六二[1] 

机构地区：[1]南方医科大学附属顺德第一人民医院重症医学科,佛山528300 [2]南方医科大学附属顺德第一人民医院胸心乳腺外科,佛山528300 [3]南方医科大学附属顺德第一人民医院心内科,佛山528300

出　　处：《中华心血管病杂志》2016年第9期777-781,共5页Chinese Journal of Cardiology

摘　　要：目的 观察体外膜肺氧合（ECMO）治疗难治性心原性休克的效果,并探讨其影响因素.方法 回顾性分析顺德第一人民医院自2013年5月至2015年11月经ECMO救治的难治性心原性休克患者.观察并记录入选患者ECMO前状态、应用ECMO时机,ECMO并发症及疗效,并收集入选患者ECMO 2 h前及2、6、24和48 h后的血液动力学数据及血管活性药物量.结果 共入选患者10例,女性6例、男性4例,年龄12 ～ 56岁,其中暴发性心肌炎5例、急性心肌梗死4例、心脏破裂1例.入选患者在使用ECMO前,左心室射血分数为（31.4±10.2）％,APACHEⅡ评分26.6±10.8.8例患者出现心跳骤停,心肺复苏时间10 ～ 300 min,3例植入主动脉内球囊反搏.ECMO支持2h后,入选患者的中心静脉压降低、血压升高、心率减慢、中心静脉血氧饱和度升高、多巴酚丁胺减量（P均＜0.05）.ECMO支持6h后,乳酸水平降低、去甲肾上腺素减量（P均＜0.05）.ECMO支持24、48 h后,血液动力学保持稳定,休克明显改善.并发症,3例患者出现置管部位或下肢感染,2例患者发生股动脉血栓,2例患者出现下肢缺血性损害,2例患者置管部位出血.10例患者ECMO辅助时间为2～ 220 h,撤机成功率90％ （9/10）,生存出院率60％ （6/10）,2例患者由于应用ECMO时机偏晚导致死亡,另外2例患者由于严重肢体并发症死亡.结论 ECMO能迅速改善心原性休克患者血液动力学稳定性,而准确把握应用ECMO时机、减少肢体并发症是提高ECMO疗效的关键.Objective To observe the clinical efficacy and factors associated with outcome of extracorporeal membrane oxygenation （ECMO） in refractory cardiogenic shock patients.Methods Patients with refractory cardiogenic shock received ECMO treatment in our hospital from May 2013 to November 2015 were retrospectively analyzed.The clinical status before ECMO support,ECMO timing,complications and outcome were observed and analyzed.The hemodynamic data and the amount of vasoactive drugs at 2 hours before ECMO support and at 2,6,24 and 48 hours after ECMO support were collected and compared.Results Ten refractory cardiogenic shock patients were included in this study （5 acute fulminant myocarditis patients,4 acute myocardial infarction patients,1 myocardial rupture patient （6 males,4 females,age ranged 12 to 56 years）.Before ECMO,the mean left ventricular ejection fraction （LVEF） was （31.4 ± 10.2）％,the mean score of APACHE Ⅱ was 26.6 ± 10.8.Eight patients developed cardiac arrests and the duration of CPR ranged from 10 to 300 minutes and three patients received IABP.CVP decreased,BP increased,HR decreased,ScVO2 increased,dose of dobutamine decreased at 2 hours after ECMO support.After ECMO support for 6 hours,lactate decreased,dose of norepinephrine decreased.After ECMO support for 24 and 48 hours,hemodynamics became stable and shock was significantly improved.Complication including infection of limb and catheterization site occurred in 3 patients,femoral arterial thrombosis occurred in 2 patients,critical limb ischemia occurred in 2 patients,hemorrhage at the catheterization site occurred in 2 patients.The duration of ECMO ranged from 2 to 220 hours.Nine patients could be weaned off ECMO support and 6 patients survived to hospital discharge.Two patients died due to too late ECMO support,the other two patients died due to severe complication of limb.Conclusions ECMO can rapidly improve hemodynamic stability of patients with cardiogenic shock.Accurate assessing the timing of ECMO support and decreasing c

关 键 词：休克 心原性 体外膜肺氧合 

分 类 号：R459.7[医药卫生—急诊医学]