急性暴发性心肌炎患者体外膜肺氧合治疗后左心收缩功能观究  

Clinical study of extracorporeal membrane oxygenation and left ventricular function in patients with acute fulminant myocarditis

作　　者：张忠满 陈旭锋 张劲松 梅勇 吕金如 张刚 胡德亮 李伟 张华忠 孙峰 吴娟 高永霞 黄夕华 张慧 Zhang Zhongman;Chen Xufeng;Zhang Jinsong;Mei Yong;Lv Jinru;Hu Deliang;Zhang Gang;Li Wei;Zhang Huazhong;Sun Feng;Wu Juan;Gao Yongxia;Huang Xihua;Zhang Hui(Department of Emergency Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029,China)

机构地区：[1]南京医科大学第一附属医院急诊医学中心,南京210029

出　　处：《中华急诊医学杂志》2020年第2期213-216,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨急性暴发性心肌炎(AFM)患者体外膜肺氧合(ECMO)治疗后左心收缩功能评估方法。方法收集2018年8月至2018年11月收住南京医科大学第一附属医院(江苏省人民医院)急诊监护病房的7例AFM患者。所有患者均行静脉-动脉(V-AECMO)辅助治疗,观察V-AECMO治疗期间相关并发症、出院存活情况。所有患者出院前均行经胸超声心动图(TTE)、放射性核素静息心肌灌注显像(SPECT)和心脏磁共振(CMR)等影像学检查,比较TTE及CMR对左心收缩功能(LVEF)的评价价值°结果7例AFM患者均成功撤机,2例发生膜氧合器血浆渗漏,4例股动脉置管部位渗血,2例股动脉置管处拔管后形成假性动脉瘤。TTE与CMR测量LVEF比较差异无统计学意义[(62.4±6.8)%vs(58.9±8.2)%,P>0.05]。在评估心肌病理改变及冠状动脉血流灌注方面,CMR及SPECT优于TTE。结论ECMO是抢救AFM的一种有效的机械治疗手段,TTE简便易行,在单纯评估左室收缩功能方面,TTE不劣于CMR,CMR从细胞水平反应心肌细胞病理改变,SPECT反应冠状动脉血流灌注情况。Objective To evaluate left ventricular systolic function(LVEF)after extracorporeal membrane oxygenation(ECMO)in patients with acute fulminant myocarditis(AFM).Methods Seven patients were admitted in the First Affiliated Hospital of Nanjing Medical University from August 2018 to November 2018.All the patients accepted veno-arterial extracorporeal membrane oxygenation(V-AECMO).Complications associated with ECMO and clinical outcome were documented.Transthoracic echocardiography(TTE),single photo emission computed tomography(SPECT),and cardiac magnetic resonance(CMR)were performed to evaluate LVEF.Results Seven patients were successfully weaned from V-AECMO,2 of whom had oxygenator leakage,4 had femoral artery bleeding after decannulation,and 2 had femoral artery pesudoaneurysm.There was no statistical difference in LVEF evaluation between TTE and CMR[(62.4±6.8)%vs(58.9±8.2)%,P>0.05].CMR and SPECT further revealed myocardial pathological change and coronary arterial blood perfusion.Conclusions ECMO is recommended in patients with AFM.TTE is simple and easy to perform and is not inferior to CMR in LVEF evaluation.CMR can reflect pathological changes of cardiomyocytes at the cellular level,and SPECT can reflect coronary perfusion.

关 键 词：体外膜肺氧合 暴发性心肌炎 左心收缩功能 

分 类 号：R542.21[医药卫生—心血管疾病]