体外膜肺氧合治疗暴发性心肌炎患者的临床研究

目的探讨体外膜肺氧合（ECMO）对暴发性心肌炎（FM）患者的临床治疗效果。 方法收集2009年9月至2015年10月入住杭州市第一人民医院危重病医学科的8例FM患者，所有患者均为常规治疗疗效不佳，遂立即行静脉-动脉模式ECMO（VA-ECMO）辅助治疗。观察患者疗效，并对患者治疗前后肌酸激酶、肌酸激酶同工酶（CKMB）、肌钙蛋白Ⅰ、天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、血肌酐、血乳酸、心胸比例及左室射血分数（LVEF）进行比较。并根据股动静脉置管法将所有患者分成外科手术组及超声组，每组4例，比较两组患者置管时间及并发症的发生情况。 结果6例患者心功能恢复正常，成功撤机，2例患者由于心功能无法逆转最终死亡。ECMO辅助治疗后肌酸激酶（586 ± 461）U/L vs.（90 ± 38）U/L，t = 2.721，P = 0.042]、血肌酐（153 ± 70）μmol/L vs.（966 ± 20）μmol/L，t = 3.866，P = 0.012]、血乳酸（6.25 ± 3.67）mmol/L vs.（1.23 ± 0.29）mmol/L，t = 3.236，P = 0.023]及LVEF（0.21 ± 0.16）vs.（0.47 ± 0.05），t = 4.416，P = 0.007]较治疗前比较，差异均有统计学意义。同时，采用外科手术切开直视下股动静脉置管方法，所需时间为（72 ± 10）min，超声引导下紧急留置了股动静脉管，所需时间为（24 ± 5）min。两种方法比较，差异有统计学意义（t = 7.908，P = 0.004），且无其他不良反应及并发症发生。 结论ECMO是抢救FM的一种有效机械辅助方法，且联合超声引导下的股动静脉置管技术救治效果更好。

Clinical study of extracorporeal membrane oxygenation in patients with fulminant myocarditis

ObjectiveTo explore the clinical effect of the extracorporeal membrane oxygenation (ECMO) in patients with fulminant myocarditis (FM). MethodsObserving 8 FM patients admitted to Critical Care Medicine in Hangzhou First People's Hospital from September 2009 to October 2015. All patients accepted vein-artery extracorporeal membrane oxygenation (VA-ECMO) after unsatisfactory results with conventional therapy. The levels of creatine kinase, creatine kinase isoenzyme MB (CK-MB), troponin Ⅰ (TNⅠ), aspartate aminotransferase (AST), actate dehydrogenase(LDH), serum creatinine, blood lactic acid, cardiothoracic ratio and left ventricular ejection fraction (LVEF) before and after VA-ECMO were compared. Meanwhile, all the patients were divided into the surgical group and ultraphonic group accroding to catheter of femoral arterio-venous, 4 patients in each group, and the time of insertion and the occurrence of complications were compared. ResultsSix patients were successfully weaned off and fully recovered cardiac function, while 2 patients eventually died because of heart function irreversible. The levels of creatine kinase (586 ± 461) U/L vs. (90 ± 38) U/L, t = 2.721, P = 0.042], serum creatinine(153 ± 70) μmol/L vs. (966 ± 20) μmol/L, t = 3.866, P = 0.012], blood lactic acid (6.25 ± 3.67) mmol/L vs. (1.23 ± 0.29) mmol/L, t = 3.236, P = 0.023] and LVEF (0.21 ± 0.16) vs. (0.47 ± 0.05), t = 4.416, P = 0.007] showed significant differences before and after VA-ECMO. The time of insertion in the ultraphonic group was much shorter than that in the surgical group (24 ± 5) min vs. (72 ± 10) min, t = 7.908, P = 0.004], and no other adverse reactions and complications happened. ConclusionECMO is one of the most effective mechanical circulation support devices, and combined with ultrasound can be better in FM patients.