107例体外膜肺氧合并发症回顾分析

目的:总结阜外心血管病医院107例应用体外膜肺氧合(ECMO)支持治疗患者的并发症发生情况,探讨ECMO并发症的发生和防治,提高ECMO救治水平。方法:阜外医院2004年12月至2008年12月共对107例患者行ECMO支持治疗,回顾性分析总结其临床资料,探讨其并发症发生情况、原因、防治及并发症对ECMO结果的影响。结果:ECMO机械并发症主要有氧合器渗漏(28.4%)、氧合器置换(27.5%)及管路血栓(20.6%)等;机体并发症主要有出血和渗血(32.7%)、肾功能不全(28.3%)、溶血(14.0%)、感染(14例;13.1%)、神经系统并发症(11.2%)、肢体远端缺血(9例;8.4%)及多器官功能衰竭(6例;5.6%)等。肾衰、肢体缺血坏死、多器官功能衰竭(MSOR)及DIC等并发症影响患者预后。结论:ECMO并发症较多,危害较大,应尽量减少和避免并发症,对其积极治疗,进一步提高ECMO的救治水平。

Retrospective analysis of complications of 107 patients managed by extracorporeal membrane oxygenation in fuwai hospital

Objective： To retrospectively investigate and analyze the complications of 107 consecutive ECMO cases performed in Fuwai hospital from Dec. 2004 to Dec. 2008. Methods：107 patients with the ECMO supported in Fuwai hospital were studied for the incidence of complications. The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique. All patients were applied veno-artery ECMO and activated clotting time （ACT） was maintained between 120-180 sec and heparin usage dose was 5-20 U/（kg·h）. Mean blood flow was 40-220 mL/（kg·min） during ECMO assistant period. Results： We support 107 patients （age range 5days-76 years,median age （28. 86 ± 25. 20） years; weight range 3. 2-100 kg, median weight （43. 49 ± 29. 04） kg with extracorporeal membrane oxygenation. 68 patients （63. 6% ） weaned off successfully from ECMO. 62 of them were discharged and 6 died of post-operative complications. 45 patients could not weaned off from ECMO. Total survival discharge rate was 57. 9% . They suffered the complications, such as bleeding,renal failure,infection,neurological complications,lim ischemia MSOF and oxygenator plasma leakage with the incidence of 32. 7% ,28. 3% ,13. 1% ,11. 2% ,8. 4% ,5. 6% and 28. 4% respectively. renal failure,lim ischemia,MSOF,DIC are significantly related to nonsurvival rate. Conclusion： the complications increases the risk of ECMO support. Bleeding and oxygenator plasma leakage are the most important complications of ECMO. During the ECMO treatment,it is also important of prevent from the complications. Once they occur,active therapies must be carried out to save the patients lives.