体外膜肺氧合对心脏术后心肺复苏患者的应用

目的:探讨体外膜肺氧合技术(ECMO)在成年心脏手术后心肺复苏(CPR)困难患者的应用经验。方法:回顾分析2010年1月至2012年9月期间,7例心脏手术后因CPR困难应用ECMO救治的成年患者的临床资料,男性4例,女性3例,年龄42～65岁,平均(54±7)岁,其中冠状动脉旁路移植术(CABG)6例,主动脉瓣置换术1例。全部患者均经股动静脉插管建立ECMO辅助。结果:7例患者CPR时间40～65 min,平均(53±7)min,建立ECMO辅助后全部患者均恢复自主心律,ECMO辅助时间36～128 h,平均(85±26)h,监护室停留时间2～8d,平均(5±1)d。辅助24h后患者平均动脉压(MBP)、血乳酸(Lac)及正性肌力药物评分(IS)均明显改善。6例(85.7%)患者成功撤离ECMO辅助,其中3例(42.9%)存活出院,1例患者因无法脱机而死亡,3例成功脱机后因感染及中枢神经系统并发症死亡;4例患者同时应用主动脉内球囊反搏(IABP),3例进行肾替代治疗(CRRT)。结论:体外膜肺心肺复苏(ECPR)可以提供紧急生命支持,挽救部分常规方法复苏困难的心脏术后心脏骤停患者的生命。

The application of extracorporeal membrane oxygenation in cardiac arrest after cardiac surgery

Objective:To discuss the effects of extracorporeal membrane oxygenation(ECMO) technology in patients received cardio-pulmonary resuscitation(CPR) after cardiac surgery.Methods:7 cases applied ECMO after cardiac surgery due to CPR in vain from January 2010 to September 2012 were retrospective analysed.The patients include 4 males and 3 females,aged 42～65 years,mean(54± 7) years old,6 of which were underwent coronary artery bypass graft(CABG),1 case was underwent aortic valve surgery.these patients were urgent established ECMO through femoral vein catheterization.Results:The CPR time is 40～65min,mean(53±7) min.All patients recovered autonomous heart rhythm,ECMO assisted time is 36～128 h,mean(85±26) h.Intensive care time is 2～8 d,mean time is(5±1)d.The mean arterial blood pressure(MBP),blood lactate and positive inotropic drug score(IS) were significantly improved after 24 h.6 patients(85.7%) were successfully weaned from ECMO,3 of which(42.9%) survived to discharge.1 patient died due to failure in weaning from ECMO.During ECMO supporting,4 patients were applied intra-aortic balloon pump(IABP),3 patients were received renal replacement therapy(CRRT).3 patients died of complications of the infection and the complication of central nervous system after weaning from ECMO.Conclusion: ECMO could provide urgent life support and save lives for patients with cardiac arrest that difficult rescued by conventional methods after cardiac surgery.