体外膜肺氧合用于冠状动脉旁路移植术

目的总结体外膜肺氧合（ECMO）对心脏冠状动脉旁路移植术（CABG）术后患者进行支持治疗的结果和临床经验。方法2004年12月至2010年12月，我院共计对30例CABG术后心肺功能衰竭患者行ECMO辅助支持治疗。以患者院内死亡或生存结果，将其分为两组。回顾性分析这些患者的临床资料，调查患者基本情况，辅助原因，辅助时间，并发症及预后。结果30例出院组和死亡组患者，男26例，女4例。25例（83．3％）患者脱机，其中3例脱机后死亡，22例存活出院（73．3％）。5例不能撤离ECMO，终止治疗，院内死亡。出院患者平均ECMO支持时间42—235（129．36±63．58）h，死亡患者平均ECMO支持时间28-152（77．13±45．22）h，有统计学意义（P=0．042）；出院组ECMO前平均动脉压（MAP）明显高于死亡组，乳酸水平明显低于死亡组（P〈0．05）；并发症主要有出血和渗血、肢体坏死、肾功能不全、感染等。结论ECMO可以为CABG术后心肺功能衰竭患者提供有效支持治疗。尽早使用ECMO支持治疗，积极防治并发症是ECMO成功的关键。

Clinical application of extracorporeal membrane oxygenation for refractory cardiogenic shock after coronary artery bypass grafting surgery

Objective To evaluate the results and summarize the experiences of temporary extracorporeal membrane oxygenation(ECMO) support for patients underwent coronary artery bypass grafting(CABG) surgery with postcardiotomy cardiogenic shock or/and with respiratory failure.Methods A retrospective study was performed which included 30 consecutive patients receiving ECMO support after CABG surgery because of refractory postcardiotomy cardiogenic shock or with respiratory failure from December 2004 to December 2010.ECMO implantation was performed via the femoral vessels and patients were placed on ECMO using a heparin-bonded circuit.The clinical data of the patients,duration of ECMO support,complications,turnovers and so on were recorded.Results 26 patients were male and 4 patients were female.Average age was 58.43±16.25 years.The mean ECMO supporting time was 117.45±78.20 hours.25 patients(83.3%) were successfully weaned from ECMO,22 patients(73.3%) were discharged from hospital.The risk factors of failure to withdraw ECMO were the duration of ECMO support,mean arterial pressure and refractory severe metabolic acidosis.The main complications were bleeding,ischemia of the lower limbs,renal failure,brain injury and infection,with the incidence of 30.0%,20.0%,16.7%,13.3% and 13.3% respectively.Conclusion ECMO is an acceptable technique for short-term treatment of refractory low cardiac output or with respiratory failure after coronary artery bypass grafting surgery of coronary artery disease.