体外膜肺氧合在合并巨大左心室心脏手术术后心功能不全中的应用

目的:总结对合并有巨大左心室心脏手术术后出现心功能不全者应用体外膜肺氧合(extracorporeal membrane oxy-genation,ECMO)治疗的效果,与应用该技术的经验。方法:对30例合并巨大左心室心脏手术术后出现心功能不全患者经行EC-MO治疗,采用股静脉-动脉模式辅助。结果:运用ECMO治疗时间为(92.2±12.9)h,25例患者心功能明显改善,治疗后左室大小(57.6±4.19)mm,射血分数(EF)0.55±0.03.射血分数/体表面积(EF/S)0.34±0.04.三者与治疗前有显著性差异(P<0.01)。最终20例康复出院,3例脱机后死于感染,2例脱机后死于多器官的并发症,5例无法脱机。结论:合并巨大左心室心脏手术风险大,死亡率高,易出现术后严重的心功能不全,行ECOM治疗能显著改善患者的心功能,是一种有效的心脏辅助方法。但需掌握好使用ECMO的时机,做好转流期间的管理,才能够提高ECMO的成功率。

Application of extracorporeal membrane oxygenation for cardiac insuffic iency after cardiac surgery in patients with huge left ventricle

Objective To summarize the treatment effects and the experiences of extracorporeal membran e oxygenation（ECMO） for cardiac insufficiency after cardiac surgery in patients with huge left ventricle.Method For 30 cases with huge left ventricle showed cardiac insufficiency after heart surgery were treated by ECMO technique,using the femoral vein-artery m ode.Results The treatment time of ECMO was（92.2±12.9） h,the cardiac function of 25 cases was improved o bviously after treatment,the left ventricular size was（57.6±4.19） mm,the e je ction fraction（EF） was（0.55±0.03）,ejection fraction/surface area（EF/S） wa s （0.34±0.04）,and the three indexes showed significant difference compared wit h that of before treatment（P0.01）.Finally,20 cases got rehabilitation and d ischarge,3 cases died of infections after taking off the support of ECMO,2 cas es died of multiple organ complications after taking off the support of ECMO,an d 5 cases could not take off the support of ECMO.Conclu s i on The patients with huge left ventricular heart surgery has high mortality risk,usually appears severe cardiac insufficiency af ter operation,and ECOM can improve the patients′ cardiac function markedly,wh ic h is an effective cardiac assist method.We should grasp the opportunity of usin g ECMO,do well in the management of flow period,to improve the ECMO success rat e.