体外膜肺氧合技术在人工心脏瓣膜置换术后泵衰竭中的应用

目的研究心脏瓣膜置换术后泵衰竭应用体外膜肺氧合(extra corporeal membrane oxygenation,ECMO)支持治疗的效果,为重症心脏瓣膜病患者围术期循环辅助管理提供参考。方法选取东莞康华医院2012年3月至2018年8月收治的心脏瓣膜置换术患者867例,其中18例患者术后出现泵衰竭应用ECMO继续进行循环支持治疗的资料。观察分析患者血浆乳酸、脑钠肽(brain natriuretic peptide,BNP)、肌酐浓度、血管活性药物:肾上腺素及多巴胺使用剂量和心指数在ECMO建立时、运行24 h及撤机时的变化。结果18例泵衰竭应用ECMO支持治疗的心脏瓣膜置换术后患者的血浆乳酸、BNP、肌酐浓度及肾上腺素、多巴胺药物使用剂量在应用ECMO支持治疗即时、运行24 h及停止时呈现显著降低趋势,而心指数则出现逐步升高趋势,差异有统计学意义(P<0.05)。围术期因ECMO严重并发症导致多器官功能衰竭而死亡6例。结论应用ECMO支持治疗人工心脏瓣膜置换术后泵衰竭,可有效辅助治疗循环衰竭,进而降低外科换瓣患者手术死亡率。

Application of extra corporeal mem brane oxygenation in patients with pump failure after cardiac valve replacement

Objectives To study the effect of extracorporeal membrane oxygenation(ECMO)support therapy inpatients with pump failure after cardiac valve replacement,and to provide references for perioperative circulation man-agement of patients with severe valve disease.MethodsTotally 867 patients underwent heart valve replacement wereselected from March 2012 to August 2018 in Dongguan Kanghua Hospital.Among them,18 patients suffered frompump failure and received ECMO for continuous circulatory support.Plasma concentrations of lactate,brain natriureticpeptide(BNP),creatinine;dosage of vasoactive drugs:adrenaline and dopamine;heart index,were observed andanalyzed during the establishment of ECMO,24 hours of operation and weaning.ResultsPlasma concentrations oflactate,BNP,creatinine,adrenaline and dopamine dosage of the 18 patients with pump failure after cardiac valvereplacement treated with ECMO support showed a significant decreasing trend in the immediate,24 hours running andstopping time of ECMO support,while cardiac index showed a significant increasing trend(P<0.05).During periopera-tive period,6 cases died of multiple organ failure due to severe ECMO complications.ConclusionsThe application ofECMO support in the treatment of patients with pump failure after heart valve replacement can play an effective adjuvant treatment of circulatory failure,thereby reducing the operative mortality of patients underwent surgical valve replacement.