体外膜肺氧合治疗暴发性心肌炎患者的临床研究  

Clinical study of extracorporeal membrane oxygenation in patients with fulminant myocarditis

作　　者：胡伟航[1] 刘长文[1] 胡炜[1] 朱英[1] 王剑荣[1] 刘炳炜[1] 郑永科[1] 陆骏[1] 陈斓[2] Hu Weihang Liu Changwen Hu Wei Zhu Ying Wang Jianrong Liu Bingwei Zheng Yongke Lu Jun Chen Lan(Department of Critical Care Medicine Department of Electrocardiogram, Hangzhou First People＇s Hospital, Hangzhou 310006, China)

机构地区：[1]杭州市第一人民医院危重病科,杭州310006 [2]杭州市第一人民医院心电功能科,杭州310006

出　　处：《中华危重症医学杂志（电子版）》2016年第6期371-375,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省医药卫生科技计划项目(2011kyb062)

摘　　要：目的探讨体外膜肺氧合(ECMO)对暴发性心肌炎(FM)患者的临床治疗效果。方法收集2009年9月至2015年10月入住杭州市第一人民医院危重病医学科的8例FM患者,所有患者均为常规治疗疗效不佳,遂立即行静脉-动脉模式ECMO(VA-ECMO)辅助治疗。观察患者疗效,并对患者治疗前后肌酸激酶、肌酸激酶同工酶(CKMB)、肌钙蛋白Ⅰ、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、血肌酐、血乳酸、心胸比例及左室射血分数(LVEF)进行比较。并根据股动静脉置管法将所有患者分成外科手术组及超声组,每组4例,比较两组患者置管时间及并发症的发生情况。结果 6例患者心功能恢复正常,成功撤机,2例患者由于心功能无法逆转最终死亡。ECMO辅助治疗后肌酸激酶[(586±461)U/L vs.(90±38)U/L,t=2.721,P=0.042]、血肌酐[(153±70)μmol/L vs.(966±20)μmol/L,t=3.866,P=0.012]、血乳酸[(6.25±3.67)mmol/L vs.(1.23±0.29)mmol/L,t=3.236,P=0.023]及LVEF[(0.21±0.16)vs.(0.47±0.05),t=4.416,P=0.007]较治疗前比较,差异均有统计学意义。同时,采用外科手术切开直视下股动静脉置管方法,所需时间为(72±10)min,超声引导下紧急留置了股动静脉管,所需时间为(24±5)min。两种方法比较,差异有统计学意义(t=7.908,P=0.004),且无其他不良反应及并发症发生。结论 ECMO是抢救FM的一种有效机械辅助方法,且联合超声引导下的股动静脉置管技术救治效果更好。Objective To explore the clinical effect of the extracorporeal membrane oxygenation （ECMO） in patients with fulminant myocarditis （FM）. Methods Observing 8 FM patients admitted to Critical Care Medicine in Hangzhou First People＇s Hospital from September 2009 to October 2015. All patients accepted vein-artery extracorporeal membrane oxygenation （VA-ECMO） after unsatisfactory results with conventional therapy. The levels of creatine kinase, creatine kinase isoenzyme MB （CK-MB）, troponin I （TN I ）, aspartate aminotransferase （AST）, actate dehydrogenase （LDH）, serum creatinine, blood lactic acid, eardiothoracic ratio and left ventrieular ejection fraction （LVEF） before and after VA-ECMO were compared. Meanwhile, all the patients were divided into the surgical group and nltraphonie group accroding to catheter of femoral arterio-venous, 4 patients in each group, and the time of insertion and the occurrence of complications were compared. Results Six patients were successfully weaned off and fully recovered cardiac function, while 2 patients eventually died because of heart function irreversible. The levels of creatine kinase [（586 ± 461） U / L vs. （90 ± 38） U / L, t = 2.721, P = 0.042], serum creatinine [（153± 70） μmol / L vs. （966 ±20） μmol / L, t = 3.866, P= 0.012], blood lactic acid [（6.25 ± 3.67） mmol/ L vs. （1.23 ± 0.29） mmol / L, t = 3.236, P = 0.023] and LVEF [（0.21 ±0.16） vs. （0.47 ± 0.05）, t =4.416, P= 0.007] showed significant differences before and after VA- ECMO. The time of insertion in the ultraphonic group was much shorter than that in the surgical group [（24 ± 5） min vs. （72 ± 10） min, t = 7.908, P = 0.004], and no other adverse reactions and complications happened. Conclusion ECMO is one of the most effective mechanical circulation support devices, and combined with ultrasound can be better in FM patients.

关 键 词：体外膜肺氧合 心肌疾病 暴发性心肌炎 

分 类 号：R542.21[医药卫生—心血管疾病]