体外膜肺氧合在心血管急危重症的临床应用  

The clinical application of extracorporeal membrane oxygenation in severe cardiovascular diseases

作　　者：卢安东 潘晨亮[1] 雷鹏[1] 蔡玮婷 赵存瑞 王俊乾 王淑萍 张丽霞[1] 张博[1] 白明[1] 张钲[1] LU An-dong;PAN Chen-liang;LEI Peng;CAI Wei-ting;ZHAO Cun-rui;WANG Jun-qian;WANG Shu-ping;ZHANG Li-xia;ZHANG Bo;BAI Ming;ZHANG Zheng(Department of Heart Center,the First Hospital of Lanzhou University,Lanzhou 730050,China)

机构地区：[1]兰州大学第一医院心脏中心

出　　处：《中国介入心脏病学杂志》2019年第11期607-613,共7页Chinese Journal of Interventional Cardiology

基　　金：甘肃省自然科学基金(17JR5RA268)

摘　　要：目的总结体外膜肺氧合(ECMO)在心血管急危重症临床应用的经验,评价其疗效。方法纳入2019年3月至2019年9月兰州大学第一医院收治并行ECMO辅助治疗的患者24例。其中,经皮冠状动脉介入治疗(PCI)组12例均在手术室建立ECMO,心原性休克组12例均在冠心病重症监护室(CCU)建立ECMO。回顾性分析24例患者的临床资料。结果 PCI组12例均在导管室手术完成后顺利撤离ECMO(脱机率12/12),12例均存活出院(生存率12/12);ECMO辅助时间1.3~4(2.6±1.5)h,辅助流量1.7~2.8(2.1±0.4)L/min;2例联合应用主动脉内球囊反搏(IABP)治疗。PCI组完全再血管化达11例(11/12),1例因右冠状动脉慢性完全闭塞反复尝试后未开通。PCI组患者术后第7天左心室射血分数(LVEF)较术前差异无统计学意义(P>0.05)。心原性休克组12例患者中10例顺利脱离ECMO(脱机率10/12),8例存活出院(存活率8/12),2例成功撤除ECMO后死亡(下消化道出血1例,无法脱离IABP 1例);ECMO辅助时间73~223(139.2±46.6)h;术后第7天LVEF较术前明显增加(P<0.05)。24例患者均无机械故障及氧合器故障,无脱管,无下肢缺血坏死,无心脏压塞;共发生出血并发症11例。结论 ECMO是急危重症冠心病行PCI的重要的保驾护航手段之一,可以使得心原性休克患者获益,提高心原性休克生存率。高效的ECMO团队、ECMO时机的把握、精细化个体化管理、有效控制和预防并发症是ECMO救治成功的关键因素。Objective To summarize the clinical application experience of extracorporeal membrane oxygenation(ECMO) in patients with severe and critical cardiovascular diseases and to evaluate its effectiveness. Methods From March 2019 to September 2019,24 patients who were performed ECMO therapy were admitted in our hospital, among whom,12 cases were percutaneous coronary interventions(PCI) aided by ECMO due to high risk complex coronary artery disease,8 cases were acute myocardial infarction(MI) combined with cardiogenic shock(CS),3 cases were fulminant myocarditis and 1 case of perinatal cardiomyopathy. Retrospective analyses were conducted on the clinical data of these 24 patients. Results Procedures for the 12 cases of high risk coronary heart disease aided by ECMO were successfully completed,and ECMO were withrawn immediately after the surgery. The mean age was(62.0±9.1)years, mean ECMO support time was(2.6±1.5)h, the complete revascularization proportion was 11/12 and there was no significant decrease of the left ventricular ejection fraction(LVEF) after PCI compared with baseline(P<0.05). All of 12 patients were successfully discharged(survival rate was 12/12). The rest 12 patients presented with cardiac shock and poor respond to drugs and conventional treatment, who were all received ECMO support treatment. The mean age was(49.5±12.3) years, mean ECMO support time was(139.2±46.6) h. The BNP before weaning decreased significantly compared with the first day of ECMO. The LVEF increased significantly on the 7 th day after surgery(P<0.05). ECMO was removed in 10 cases successfully(withdraw rate of 10/12),8 patients were survived and discharged(survival rate was 8/12). Complications:6 cases were treated with intra-aortic balloon pump(IABP) due to left heart function failure and swelling in the left ventricle,3 cases received continuous renal replacement therapy(CRRT) treatment because of renal insufficiency;there were 8 cases of intubation area bleeding, 2 cases of gastrointestinal bleeding, 1 case of cerebral hemorr

关 键 词：体外膜肺氧合 心血管急危重症 经皮冠状动脉介入治疗 心原性休克 并发症 

分 类 号：R543[医药卫生—心血管疾病] R459.7[医药卫生—内科学]