经皮房间隔造口左心引流在静-动脉体外膜肺氧合治疗中的应用  

Application of ballon atrial septostomy for left heart venting during extracorporeal membrane oxygenation

作　　者：李丁扬 张刚成[1] 沈群山[1] 刘燕[2] 曹乃文 周岳廷 Li Dingyang;Zhang Gangcheng;Shen Qunshan;Liu Yan;Cao Naiwen;Zhou Yueting(Congenital Heart Disease Center,Wuhan Asia Heart Hospital,Wuhan 430000,China;Department of Extracorporeal Circulation,Wuhan Asia Heart Hospital,Wuhan 430000,China)

机构地区：[1]武汉亚洲心脏病医院先天性心脏病中心,430000 [2]武汉亚洲心脏病医院体外循环科,430000

出　　处：《中华胸心血管外科杂志》2020年第2期89-93,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：湖北省卫计委科研项目(WJ2015MA019);武汉市卫计委科研项目(WX18A01)。

摘　　要：目的观察经皮房间隔造口术在静-动脉体外膜肺氧合(V-A ECMO)治疗中的左心引流效果,探讨其安全性、有效性。方法回顾性分析2017年3月至2019年1月9例接受V-A ECMO治疗时以房间隔造口手术进行左心引流的患者临床资料,其中男5例,女4例;年龄12~72岁。心脏外科术后顽固性低心排血量综合征4例,重症病毒性心肌炎3例,急性心肌梗死2例。记录患者基础资料、手术数据、转归与随访结果等临床资料。结果全组患者均成功完成经皮房间隔造口术,平均手术时间42.2 min。术后出现前纵隔血肿1例。ECMO辅助期间无肺水肿或血栓形成事件,无再做治疗关闭房间隔造口。结论经皮房间隔造口手术可安全有效地进行左心引流,利于严重左心衰患者术后恢复。Objective To discuss whether balloon atrial septostomy(BAS)can provide safe and effective left ventricular venting for venoarterial extracorporeal membrane oxygenation(V-A ECMO).Methods From March 2017 to January 2019,9 patients received BAS for left ventricular venting during V-A ECMO treatment in our hospital,including 5 males and 4 females,aged 12-72 years.There were 3 cases of severe myocarditis,4 cases of low cardiac output after cardiac surgery,and 2 cases of acute myocardial infarction.Basic data,procedure data,outcome and follow-up were recorded.Results BAS were successfully performed in 9 patients.Procedure time on average was 42.2 min.Anterior mediastinal hematoma occurred in 1 case.There were no other procedure-related complications in the rest cases.No pulmonary edema or thrombosis occurred in all 9 cases during ECMO.No closure procedure was performed.Conclusion BAS is a safe and effective method for left ventricular venting.The procedure is conductive to the recovery of patients with severe left heart failure.

关 键 词：房间隔造口术 房间隔穿刺 体外膜肺氧合 左心引流 

分 类 号：R54[医药卫生—心血管疾病] R65[医药卫生—内科学]