摘要
目的描述性总结体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)救治心脏骤停患者的预后及实践经验。方法观察2012年1月至2017年12月陆军军医大学第一附属医院体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)团队救治的全院(胸心外科、急救部、心内科、麻醉科、重症医学科)ECPR患者的临床资料,对ECPR组成、团队配合、患者生存率及并发症等进行回顾性分析。结果 13例ECPR患者,年龄16～69岁,中位年龄44岁,其中男性8例。原发疾病包括急性心肌梗死、暴发性心肌炎、外科术后等。均采用股动静脉插管的V-A ECMO模式,从心脏骤停到ECMO建立运转时间26～83 min,中位时间46 min;ECMO支持时间为27～189 h,中位时间为111 h;ECMO撤机后到出院时间0～21 d,中位时间7 d。7例成功撤机,4例存活出院。13例患者中插管部位渗血3例(23. 08%),5例(38. 46%)急性肾功能衰竭,脑死亡1例(7. 69%),2例(15. 38%)肺部感染,1例(7. 69%)心包填塞,插管侧下肢出院轻度跛行1例(7. 69%),多器官功能衰竭3例(23. 08%)。无截肢、肢体缺血坏死并发症发生。结论熟练有效的ECMO和常规心肺复苏团队配合,尽量缩短从心脏骤停到ECMO转流的时间,是保证ECPR救治成功率的重要因素。
Objective To analyze and summarize the practical experience and prognosis of extracorporeal cardiopulmonary resuscitation (ECPR) in the resuscitation of cardiac arrest patients. Methods The clinical data of ECPR patients rescued by our extracorporeal membrane oxygenation (ECMO) team (including departments of cardiothoracic surgery, emergency, cardiology, anesthesiology and intensive care medicine) from January 2012 to December 2017 were collected and retrospectively analyzed. The components of our ECPR team, team cooperation, survival rate and complications were analyzed. Results The 13 ECPR patients were 8 males and 5 females, at an age of 16~69 (median age 44) years. Their primary diseases include acute myocardial infarction, fulminant myocarditis, postoperative surgery, and so on. All the 13 patients underwent V-A ECMO model of femoral arteriovenous intubation. The operation time from cardiac arrest to ECMO establishment was only 26 to 83 (median time 46) min, and the time of ECMO support was 27 to 189 (median time 111) h. The time from ECMO weaning to discharge was 0~21 (median time 7) d. Seven patients were successfully weaned, and 4 were discharged alive. Incision bleeding occurred in 3(23.08%) patients. Five (38.46%) patients had acute renal failure, 1 patient (7.69%) brain death, 2(15.38%) patients with pulmonary infection, 1(7.69%) patient with cardiac tamponade, 1(7.69%) patient with slight limp, and 3(23.08%) patients suffered from multiple organ failure. No complication of amputation or limb ischemia necrosis occurred. Conclusion Skilled and effective teamwork of ECMO and CPR teams, and prompt and rapid initiation of ECPR after cardiac arrest are important factors to ensure the success rate of ECPR treatment.
作者
张现普
叶茂亭
刘欣
唐令凤
陈娅
廖云姝
何萍
ZHANG Xianpu;YE Maoting;LIU Xin;TANG Lingfeng;CHEN Ya;LIAO Yunshu;HE Ping(Department of Cardiac Surgery,First Affiliated Hospital,Army Medical University (Third Military Medical University),Chongqing,400038,China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2019年第1期7-12,共6页
Journal of Third Military Medical University
基金
军事医学与战创伤救治临床新技术计划(SWH2016JSTSYB-51)
西南医院军事医学重大领域技术创新计划重点项目(SWH2017ZDCX2002)~~
关键词
体外心肺复苏
心脏骤停
体外膜肺氧合
常规心肺复苏
extracorporeal cardiopulmonary resuscitation
cardiac arrest
extracorporeal membrane oxygenation
conventional cardiopulmonary resuscitation
