摘要
目的 评价体外膜肺氧合（ECMO）在心脏手术后心肺复苏困难患者的应用效果.方法 2011年1月至2013年8月,27例成年心脏手术后心脏骤停患者因心肺复苏困难应用ECMO救治,男性19例,女性8例,年龄42 ～ 76（60±8）岁,其中冠状动脉旁路移植术20例,瓣膜手术5例,心包剥脱术及房颤射频消融术各1例.全部患者均经应用药物、实施电除颤及心脏按压等措施抢救无效紧急建立ECMO辅助.结果 27例患者心肺复苏（CPR）时间35 ～ 190 min（中位时间90min）,ECMO辅助后全部患者均恢复自主心律,ECMO辅助时间13.5 ～ 207 h（中位时间95 h）,监护室停留时间1～20 d（中位时间7d）.21例（77.8％）患者成功撤离ECMO辅助,其中13例（48.1％）存活出院.6例患者未脱离ECMO,8例成功脱机后因中枢神经系统损伤或感染诱发多器官功能衰竭死亡.ECMO辅助24 h后患者平均动脉压（MAP）、血乳酸（Lac）、正性肌力药物评分（IS）及左室射血分数（LVEF）等指标持续好转.存活组与死亡组之间在年龄、肾功能衰竭需透析（CRRT）治疗人数、复苏后即刻MAP以及复苏72 h后IS、LVEF等方面存在显著性差异.结论 ECMO可以提供紧急循环支持,挽救部分成年心脏术后心脏骤停而常规方法复苏困难的患者的生命,积极防治多脏器功能衰竭及脑损伤对改善预后有益.
Objective To evaluate the effect of extracorporeal membrane oxygenation （ECMO） support in refractory cardiac arrest （CPR） patients after cardiac surgery.Methods Between January 2011 and August 2013,ECMO resuscitation was performed in 27 consecutive patients receiving conventional CPR＞ 10 min without return of spontaneous circulation （ROSC）.There were 8 female and 19 male patients,with a mean age of （60±8） years old.The cardiac operations included off-pump coronary artery bypass grafting （n=20）,valvular operation （n=5）,pericardiectomy （n=1） and radiofrequency ablation of atrial fibrillation （n=1）.Veno-arterial extracorporeal membrane oxygenation （V-A ECMO） was established in 26 patients by cannulation of right atrium and femoral artery,and 1 of the right atrium and ascending aorta.Results The median CPR duration was 90 minutes （ranged from 35 to 190 mins）.All the patients achieved ROSC after ECMO support.Median support duration of ECMO was 95 h （ranged from 13.5 to 207 h） and the mean ICU stay was 7 d （ranged from 1 to 20 d）.21 patients （77.8％） were successfully weaned from ECMO.And 13 patients （48.1％） survived to discharge.Six patients died of unstable haemodynamics during ECMO support.And 8 patients died of multiple-organ failure or septic shock from nosocomial infections despite successful weaning.Mean arterial pressure （MAP）,blood lactate （Lac）,inotropic score （IS） and left ventricular ejection fraction （LVEF） improved gradually 24 h after ECMO support.There was a significant difference in age,the number of continuous renal replacement therapy （CRRT） treatment,MAP immediately after resuscitation,IS 72 h after resuscitation and LVEF between the survival and the death groups.Conclusion The use of ECMO resuscitation can rescue some adult patients who failed in conventional CPR after cardiac surgery.But the high rate of complications such as multiple-organ failure and serious secondary brain injury needs further improvements.
出处
《中国体外循环杂志》
2014年第2期73-76,共4页
Chinese Journal of Extracorporeal Circulation
关键词
心脏手术
心脏骤停
心肺复苏
体外膜肺氧合
Cardiac surgery
Cardiac arrest
Cardiac resuscitation
Extracorporeal membrane oxygenation
