摘要
目的总结体外膜式氧合（ECMO）支持治疗成人心脏病患者的临床经验，对辅助未成功患者的失败原因进行分析。方法2005年2月至2008年10月，应用ECMO救治58例成人心脏病患者，其中男42例，女16例；年龄44．8±17．6岁。ECMO辅助时间131．9±104．7h。冠心病24例（41．4％），心肌病11例（19．0％），心瓣膜病10例（17．20），先天性心脏病9例（15．5％）。结果院内死亡22例，11例（50％）死于多器官功能衰竭，5例（22．7％）因心功能损害严重，使用ECMO亦无法维持有效循环死亡，其余患者因出血、严重肺动脉高压缺乏后续有效治疗手段等而死亡。ECMO辅助治疗前有心脏停搏和ECMO辅助期间仍出现肾功能不全需同期使用持续肾脏替代治疗（CRRT），在死亡患者中的比率明显大于生存患者（45．5％vs．19．4％，40．9％vs．5．6％；P=0．043，0．001）。生存患者平均随访15．6个月。随访期间3例因再发心力衰竭而死亡，1例出院后死于神经系统并发症，其余32例心功能分级（NYHA）Ⅰ～Ⅱ级。结论ECMO是救治急重症成人心肺功能衰竭的有效手段。在重要器官出现不可逆损害前及时建立ECMO辅助和积极有效地预防并发症发生，是进一步提高救治成功率的关键。ECMO辅助时仍出现肾功能不全需同期使用CRRT治疗以及在ECMO开始前经历过心脏停搏是提示预后不良的危险因素。
Objective To summarize the clinical experiences of venoarterial extracorporeal membrane oxygenation （ECMO） which provides temporary cardiopulmonary assist for critical patients, and preliminary analysis of the cause of failure. Methods From February 2005 to October 2008, 58 adult patients （male 42, female 16） undergoing cardiogenic shock required temporary ECMO support. Age was 44.8＋ 17.6 years, and support duration of ECMO was 131.9＋104. 7 hours. There were 24 patients （41. 4%） with coronary heart disease, 11 patients （19. 0%） with cardiomyopathy, 10 patients （17. 2%） with cardiac valve disease, and 9 patients （15. 5%） with congenital heart disease. Results 22 patients died in hospital. 11 patients （50%） died of multisystem organ failure, 5 patients （22.7%） died of refractory heart failure despite the ECMO support. Another patients died of bleeding and severe pulmonary hypertension etc. The percentage for patients need cardiac resuscitation before ECMO support and patients with acute renal failure treated by continuous renal replacement therapy （CRRT） under ECMO support were obviously higher in dead patients than those in survivor patients （45.5% vs. 19.4%, 40.9% vs. 5.6% ; P=0. 043, 0. 001）. All of the discharged patients were reassessed, mean follow-up time were 15.6 months. Three patients died of refractory heart failure, 1 patient died of neurologic complications. The other 32 survivors were in good condition with cardiac symptom of New York Heart Association class Ⅰ or Ⅱ. Conclusion ECMO offers effective eardiopulmonary support in adults. Early intervention and control of complications could improve our results with increasing experience. Combining using CRRT during the ECMO support is associated with significantly higher mortality rate. Suffered cardiac arrest prior to ECMO also influences the survival.
出处
《中国胸心血管外科临床杂志》
CAS
2009年第3期192-195,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
体外膜式氧合
心力衰竭
成人
心脏病
Extracorporeal membrane oxygenation
Heart failure
Adult
Heart disease
