摘要
目的回顾性研究接受心脏移植手术并采用体外膜氧合(ECMO)辅助支持治疗的患者,总结临床经验,为进一步推广提供参考。方法收集中国医学科学院阜外心血管病医院接受心脏移植手术并采用ECMO支持受者的临床资料,分析受者围手术期ECMO应用情况,统计ECMO支持时间,合并使用主动脉内球囊反搏(IABP)的情况,并发症发生情况等临床资料。采用SPSS23.0软件处理,正态分布采用独立样本Student's test,非正态分布采用非参数检验Mann-Whitney U test。分类资料的组间比较采用χ2检验或Fisher确切检验法。结果所有ECMO支持模式均为静脉-动脉ECMO模式(V-A ECMO)。有8例受者成功使用ECMO过渡到心脏移植。使用ECMO的心脏移植受者中61例(89.7%)成功脱离ECMO机械辅助,48例(70.5%)存活出院。出血、术后急性肾功能不全、肺部感染等并发症是心脏移植ECMO循环支持过程中最多见的并发症。在手术室早期建立ECMO辅助循环的心脏移植受者脱机率和存活率分别为95.6%和84.4%,而在ICU床旁建立ECMO的受者脱机率和存活率分别为72.2%和27.8%,早期使用ECMO结果更好。结论ECMO机械辅助循环能对心脏移植受者提供有效的循环、呼吸功能支持,使得受者平稳渡过移植手术围术期。提倡早期、同期联合应用IABP增加重要器官的灌注,改善受者的预后,获得良好的转归。
Objective To retrospectively analyze the data of patients undergoing extracorporeal membrane oxygenation(ECMO)during perioperative period of cardiac transplantation and provide objective and reliable evidence for further clinical promotion.Methods Collect the clinical data of patients undergoing heart transplantation and ECMO support in Fuwai Hospital,analyze the duration of ECMO support,combined use of aortic balloon counterpulsation(IABP),and complications during the supporting period.All statistical analyses were processed by SPSS 23.0 software.Independent sample Student's test was employed for normal distribution and Mann-Whitney U test for abormal distribution.χ2 or Fisher exact test was utilized for comparinge the classification data between groups.Results All ECMO support models were intravenous-arterial ECMO(V-A ECMO).Eight patients successfully bridging heart transplantation through VA-ECMO.Sixty-one patients(89.7%)who had undergone cardiac transplantation were successfully weaned from ECMO while 48 patients(70.5%)survived and discharged.The most common complications during circulation support are bleeding,acute renal insufficiency,and pulmonary infection.Patients with ECMO support in the operating room had a better rate of survival and weaning off(95.6%,84.4%)than those with ECMO at the bedside of ICU(72.2%,27.8%).Conclusions ECMO can provide adequate circulation and respiratory function support for heart transplant patients,and it is an indispensable treatment for patients to go through the perioperative period of heart transplant surgery smoothly.It is advocated to use IABP combined with ECMO in the early stage and at the same time to increase the perfusion of vital organs,improve the prognosis of patients and obtain good outcomes.
作者
解衍博
侯剑峰
刘盛
宋云虎
黄洁
杜娟
吉冰洋
郑哲
胡盛寿
Xie Yanbo;Hou Jianfeng;Liu Sheng;Song Yunhu;Huang Jie;Du Juan;Ji Bingyang;Zheng Zhe;Hu Shengshou(Fuwai Cardiovascular Hospital,Chinese Academy of Medical Sciences,Beijing 100037)
出处
《中华器官移植杂志》
CAS
2021年第2期100-103,共4页
Chinese Journal of Organ Transplantation
基金
国家重点研发计划(2016YFC1300900)。
关键词
心脏移植
体外膜氧合
并发症
Heart transplantation
Extracorporeal membrance oxygenation
Complication
