摘要
目的总结人工膜肺氧合（exgacorporeal membrane oxygenation，ECMO）治疗暴发性心肌炎患儿的成功经验。方法应用ECMO联合药物治疗救治1例11岁急性重症暴发性心肌炎男性患儿。患儿同时合并心源性休克、急性心力衰竭、Ⅲ度房室传导阻滞、束支传导阻滞、多源性室性心律、阵发性多源性室性心动过速、广泛性ST—T弓背向上抬高。心脏超声：右房扩大4．4min，右室略大2．3mm，三尖瓣重度反流，左心收缩功能不全，室壁运动不协调。心肌酶谱：肌酸激酶2161U／L，肌酸激酶同工酶109U／L，α-羟丁酸脱氢酶612U／L，乳酸脱氢酶696U／L，肌钙蛋白22．1μg／L，血乳酸4．0mmol／L。先予患儿吸氧，静脉使用多巴酚丁胺、多巴胺、米力农、呋塞米、大剂量甲泼尼龙、静脉丙种球蛋白、大剂量维生素C及磷酸肌酸，患儿病情仍不稳定，且进行性加重，故建立ECMO体外辅助装置。辅助过程中继续上述药物治疗，严密监测神志、体温、心率（律）、呼吸、血压、血氧饱和度、尿量、动脉血气、血电解质、血乳酸、血糖、肝肾功能、血常规、活化凝血时间及下肢血运情况，根据结果调整药物。结果ECMO系统成功建立并持续应用7d，患儿心功能明显改善，恶性心律失常消失，未出现出血、栓塞、感染等并发症。ECMO应用过程中患儿曾出现3次心搏停止，1次心室扑动，1次心室颤动，经电除颤和抗心律失常药物联合应用均成功复律。患儿共住院20d。出院前复查心肌酶谱正常。心电图：窦性心律，电轴右偏，完全性右束支传导阻滞，Ⅰ度房室传导阻滞。心脏超声：心脏各室腔大小正常，心肌收缩功能正常，室间隔增厚（0．9cm）。出院2周后随访，心电图：窦性心律，电轴右偏，完全性右束支传导阻滞。心脏超声：心脏各室腔大小正常，心肌收缩功能正常，室间隔增厚（0．9cm）。
Objective To report the clinical experience of extracorporeal membrane oxygenation （ECMO） in the emergency management of fulminant myocarditis. Methods The patient, an 11 year-old boy, had fever for 4 day and abdominal pain,vomiting for 1 day and anuria for 12 hours. Electrocardiogram showed Ⅲ atrial-ventficular block, multifocal ventricular rhythm, bundle branch block, convulsivum multifocal ventricu- lar tachycardia,extensive low voltage, ST-T elevation at lead I, AVR, V1, V2, V3 ; and there were ST-T intru- sion,T wave inversion at lead II, III , AVR, AVF, V4 - 5. Blood creatine kinase was 2 161 U/L, reatine kinase isoenzyme 109 U/L, a-hydroxybutyrate dehydrogenase 612 U/L, lactate dehydrogenase 696 U/L, troponin I 22. 1 U/L. Echocardiogram showed fight atrium 4. 4 mm,right ventricular 2. 3 ram,severe tricuspid valve regur- gitation,left ejection fraction 33%, left ventricular fractional shortening 15%, ventricular wall motion dyssyn- chrony. Blood lactate was 4. 0 mmol/L. The patient＇s condition was still unstable after using dobutamin, dopa- mine,milrinone, furosemide, large dose methylprednisolone, intravenous human immunoglobin, phosphocreatine and so on. ECMO was used for cardio-pulmonary support. It is necessary to monitoring the consciousness, temperature,heart rate, respiration, blood pression, SaO2, urinary volume, ariterial blood gas, blood electrolytes, blood lactate ,blood glucose, liver function, renal function, blood routine, activated clotting time （ACT）, lower extremity blood supply and so on. ACT was maintained at 160 ~ 200 s. Heparin was used persistently [ 5 - 10 U/（ kg. min） ]. Results ECMO system had been successfully used for 7 days. The cardiac function of the patient was improved significantly. There was no complication, such as hemorrhage, infection, and embolism. Heart arrest in the patient occurred three times,ventricular fibrillation and ventricular flutter occurred one time respectively during ECMO. The rhythm was recovered by electric defibrillation and antiarrhyth
出处
《中国小儿急救医学》
CAS
2011年第5期423-426,共4页
Chinese Pediatric Emergency Medicine
关键词
人工膜肺氧合
暴发性心肌炎
儿童
Extracorporeal membrane oxygenation
Fulminant myocarditis
Children
