体外膜肺氧合治疗成人暴发性心肌炎的疗效分析  

Effect of Extracorporeal Membrane Oxygenation for the Treatment of Adult Patients With Fulminant Myocarditis

作　　者：王小芳[1] 杨露露[1] 肖莉丽[1] 易善婷 董建增[1,2] WANG Xiaofang;YANG Lulu;XIAO Lili;YI Shanting;DONG Jianzeng(Department of Cardiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou(450052),Henan,China)

机构地区：[1]郑州大学第一附属医院心内科,河南省郑州市450052 [2]首都医科大学附属北京安贞医院心内科

出　　处：《中国循环杂志》2019年第12期1186-1190,共5页Chinese Circulation Journal

基　　金：国家自然科学基金（81400323）;国家重点研发计划重大慢性非传染性疾病防控研究重点专项（2016YFC1301000）;河南省高等学校重点科研项目计划（15A320029）

摘　　要：目的:评价体外膜肺氧合(ECMO)治疗暴发性心肌炎(FM)的安全性和有效性。方法:回顾性分析2016年11月至2018年1月郑州大学第一附属医院收治的行ECMO治疗的12例FM患者临床资料。观察并记录ECMO应用前状态,置入后相关指标变化,联合其他机械辅助装置情况,患者转归和并发症。结果:共纳入患者12例,ECMO置入前均存在心原性休克和恶性心律失常,2例发生心脏骤停。ECMO置入24 h后,收缩压、舒张压、平均动脉压上升,乳酸下降(除外48 h),差异均有统计学意义(P均<0.05);48 h后,肌钙蛋白I、肌酸激酶同工酶明显下降,差异有统计学意义(P<0.05)。3例联合主动脉内球囊反搏辅助治疗,5例联合连续肾脏替代治疗(CRRT),6例应用有创呼吸机辅助通气。10例(83%)成功撤机,9例(75%)存活出院。并发症发生率100%。结论:ECMO可能是降低成人FM病死率的有效手段,及时启动ECMO系统、防治并发症是提高治疗成功率的关键,早期CRRT的应用对肾功能的改善和预后可能存在积极影响。Objectives: To evaluate the security and efficacy of extracorporeal membrane oxygenation(ECMO) for fulminant myocarditis in adults. Methods: We retrospectively analyzed the clinical data of patients diagnosed with fulminant myocarditis from November 2016 to January 2018 in the first affiliated hospital of Zhengzhou university and collected the baseline characteristics before ECMO, post-ECMO change of relative indexes, in combination with other mechanical equipment, the clinical outcomes and complications of ECMO.Results: 12 patients were included. Cardiac shock and malignant arrhythmia were presented in all 12 patients, of which two cases occurred cardiac arrest. After 24 hours support, the systolic pressure, diastolic pressure and mean pressure significantly elevated and the lactic acid went down(except the time of 48 hours after ECMO installing)(P<0.05). The levels of the troponin I, creatine kinase isozyme decreased significantly after 48 hours ECMO support(P<0.05). 3 cases received additional IABP and 5 cases received continuous renal replacement therapy. 6 cases were treated with breathing support by the endotracheal intubation. 10 cases withdrawed ECMO successfully and 9 cases survived to discharge. The complication was as follows: 5 acute kidney injury, 2 cases of cerebral events, 1 case of low limb arterial ischemia, 1 case of low limb venous embolism, 2 cases of infection, 3 cases of hemolysis, 6 cases thrombocytopenia. Conclusions: ECMO can effectively reduce the mortality of the patients diagnosed with FM in adults. To apply ECMO timely and prevent the complications are the key factors to improve the survival rate. The application of CRRT in the early phase of AKI may have a positive impact on the improvement of renal function and the prognosis.

关 键 词：暴发性心肌炎 体外膜肺氧合 临床预后 并发症 

分 类 号：R54[医药卫生—心血管疾病]