心脏术后体外膜肺氧合支持临床应用探讨  

Clinical application of extracorporeal membrane oxygenation support for critically ill patients after heart surgery

作　　者：卢安东[1] 郭剑[1] 苗莉霞[1] 闵凯[1] 李子林[1] 董书强[1] 董逸飞[1] 

机构地区：[1]兰州军区兰州总医院心血管外科,兰州730050

出　　处：《中国体外循环杂志》2017年第2期100-104,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结体外膜肺氧合(ECMO)在心脏术后重症患者的临床应用经验,评价其疗效。方法 2014年3月至2016年5月,回顾性分析因心脏术后心肺功能性衰竭行ECMO辅助时间>8 h以上者6例患者的临床资料。结果 6例患者中5例表现为低心排血量综合征,1例表现为严重低氧血症,药物及常规治疗效果不佳。均行ECMO辅助支持治疗(V-A模式),平均年龄(51.8±10.4)岁,ECMO平均支持时间(109.8±27.1)h,3例成功脱离ECMO(50%),1例存活出院(16.7%)。并发症:4例合并肾功能不全并行连续肾脏替代疗法(CRRT)治疗,2例插管部位出血,2例胸腔内出血,1例ECMO后感染。结论ECMO是治疗心脏术后可逆性心肺衰竭的重要支持手段,ECMO时机的把握、保护性肺通气的应用、有效控制和预防出血是ECMO救治成功的关键因素。Objective To summarize and evaluate the clinical effect of extracorporeal membrane oxygenation support for critically ill patients after heart surgery. Methods 8 patients with cardiopulmonary functional failure after heart surgery received ECMO support from March 2014 to May 2016 ,and 6 patients （support time〉8 hours）were retrospectively analyzed. Results Low cardiac output syndrome occurred in 5 patients, and acute respiratory failure happened in 1 patient, who failed to respond to routine medical therapy. All patients received V-A ECMO. The mean age was （51.8±10.4）years.The aver age support time was （ 109.8±27.1 ） hours. Three （50%） patients successfully weaned from ECMO and 1 （ 16,7% ） was discharged from hospital. Complications：renal failure with continuous renal replacement therapy was seen in 4 cases ,4 cases had hemorrhage（ 2 cases of catheter hemorrhage and 2 cases of hemothorax） and 1 case of infection after ECMO. Conclusion ECMO is an life supporting approach for patients with reversible cardiopulmonary failure after heart surgery. The keys to optimal results include earlier use of ECMO, the application of lung protective ventilation strategy, prevention and control of bleeding.

关 键 词：体外膜肺氧合 心脏术后 低心排血量综合征 连续肾替代疗法 

分 类 号：R654.2[医药卫生—外科学]