体外膜肺氧合在重症心脏病围术期中的临床应用

目的:观察体外膜肺氧合(ECMO)对重症心脏病患者围术期发生心衰的支持治疗,总结临床经验?方法:自2007年6月~2008年12月,对6例重症心脏病围术期患者进行ECMO支持治疗,所有患者均采用股动-静脉插管行ECMO支持治疗?ECMO期间维持血流动力学和呼吸指标稳定?结果:ECMO的支持时间为31~261 h,平均98 h;患者血流动力学明显改善,正性肌力药物用量也显著减少,6例患者均顺利脱机?3例康复出院,出院率50%,3例脱机后循环再次不稳定最后导致多脏器功能衰竭死亡?主要并发症为出血,肾功能衰竭,DIC等?结论:ECMO是一种重要的体外生命支持形式,对重症心脏病围术期的严重心衰提供有效的支持治疗,但需正确掌握适应证及时机,减少并发症,才能提高成功率?

The clinical application of extracorporeal membrane oxygenation for severe perioperative heart failure

Objective:To summarize the clinical effect and experience of extracorporeal membrane oxygenation (ECMO) support for perioperative severe heart failure in end-stage cardiopathy. Methods:From June 2007 to December 2008,six patients with severe perioperative heart failure in end-stage cardiopathy received ECMO support. ECMO was established in all patients by cannulation of femoral artery and vein. The hemodynamic and respiratory parameters were maintained stabilization. Results:The duration of assist ranged from 31 to 261 hours (mean 98 hours). The hemodynamics after using ECMO was improved remarkably,and the amount of inotropic drug was significantly reduced. All patients were successfully weaned from ECMO. After weaning,three patients recovered uneventfully and discharged,while three patients died of multiorgan failure. Major complication were bleeding,renal failure,DIC and so on. Conclusion:ECMO is an important extracorporeal method to support life. ECMO is an effective treatment for end-stage cardiopathy patients with severe perioperative heart failure. It is important to select patients for ECMO properly.