体外膜肺氧合技术在心肺复苏中的应用体会  

Application of extracorporeal membrane oxygenation technology in cardiopulmonary resuscitation

作　　者：鲍黎明 刘新宾 赵忠[1] 高扬[1] 张国华[1] BAO Liming;LIU Xinbin;ZHAO Zhong;GAO Yang;ZHANG Guohua(Department of Cardiac Surgery,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院心外科,100049

出　　处：《心肺血管病杂志》2020年第8期963-965,共3页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:在救治心脏骤停的患者中采用体外膜肺氧合(ECMO)技术进行体外心肺复苏治疗,以此研究其治疗应用价值。方法:选定20例运用ECMO技术进行体外心肺复苏救治的心脏骤停患者,时间选择在:2017年2月至2019年2月期间,回顾性分析所有患者的病历资料;对生存患者的心肺复苏时间、ECMO辅助时间等指标参数与死亡患者相比。结果:20例运用ECMO技术进行体外心肺复苏救治的心脏骤停患者,经抢救后,成功撤离辅助患者12例,8例患者生存出院;20运用ECMO技术进行体外心肺复苏救治的心脏骤停患者,发生院内死亡12例,合并出血、合并感染例数分别:5例、6例;ECMO前最后1次的血肌酐、乳酸与血乳酸恢复正常的时间数据差异有统计学意义(P<0.05);其中,生存组别的心肺复苏时间、ECMO辅助时间、ECMO辅助前最后1次乳酸、ECMO辅助前最后1次肌酐、体质量、ECMO治疗辅助流量、乳酸恢复正常时间、使用体外生命辅助支持恢复自主心律时间分别为:(45.55±21.11)min、116.50(56,127)min、(5.66±2.11)mmol/L、(99.76±26.65)μmol/L、(64.55±10.11)kg、(3.47±0.66)L/h、(43.67±9.56)min、(20.33±1.23)min。结论:ECMO技术是体外心肺复苏治疗的重要手段,进行ECMO技术之前的血肌酐、乳酸与血乳酸恢复正常的时间可作为判断患者预后结局的重要依据指标。Objective: To study the therapeutic value of extracorporeal membrane oxygenation(ECMO) for cardiopulmonary resuscitation in patients with cardiac arrest. Methods: 20 patients with cardiac arrest treated by ECMO and cardiopulmonary resuscitation(CPR) were selected. The time was from February 2017 to February 2019. The medical records of all patients were analyzed retrospectively. Compared with the dead patients, the indexes such as cardiopulmonary resuscitation time and ECMO auxiliary time of the surviving patients are compared. Results: ECMO were successfully weaned in 12 patients and 8 patients were discharged from hospital after rescue. In the cardiac arrest patients treated by ECMO, 12 cases died in hospital, and the number of cases complicated with hemorrhage and infection were 5 cases and 6 cases respectively. The time data of creatinine, lactic acid and blood lactic acid in the last time before ECMO were significantly different(P<0.05). Among them, The survival group’s cardiopulmonary resuscitation time, ECMO assistance time, the last lactic acid before ECMO assistance, the last creatinine before ECMO assistance, body mass, ECMO treatment assistance flow rate, lactic acid recovery time, and the recovery time of autonomic rhythm using extracorporeal life assistance support were(45.55±21.11)min, 116.50(56, 127) min,(5.66±2.11)mmol/L,(99.76±26.65)μmol/L,(64.55±10.11)kg,(3.47±0.66)L/h,(43.67±9.56)min,(20.33±1.23)min. Conclusions: ECMO technology is an important method of extracorporeal cardiopulmonary resuscitation, The time before ECMO technology for blood creatinine, lactic acid and blood lactic acid to return to normal can be used as an important indicator to judge the prognosis of patients.

关 键 词：体外膜肺氧合技术 心脏骤停 体外心肺复苏 血肌酐 

分 类 号：R54[医药卫生—心血管疾病]