体外循环心肺复苏技术在成人心脏术后心搏骤停抢救中的应用

目的 总结探讨体外循环心肺复苏(ECPR)抢救成年心脏手术后难治性心搏骤停的临床经验.方法 回顾分析2004年9月到2013年3月,应用ECPR救治28例成人心脏手术患者,其中男21例,女7例,年龄(59.4±11.5)岁.体外膜肺氧合(ECMO)辅助时间(115.5±68.2)h.冠状动脉粥样硬化性心脏病23例(82.1％),瓣膜病3例(10.7％),先天性心脏病2例(7.1％).所有患者均为静脉-动脉(V-A) ECMO.结果 18例患者成功脱机(64.3％),10例生存出院(35.7％),18例院内死亡.25例患者在ECPR前安置主动脉内球囊反搏(IABP) (89％).多器官衰竭(MSOF)是主要死亡原因(10例,35.7％).16例在ECMO期间发生细菌感染(57.1％).结论 ECPR用于抢救心脏术后心搏骤停是安全有效的.选择合适的患者非常重要.心肺复苏(CPR)期间尽早评估并进行ECPR是提高成功率和生存率的关键.改善ECPR患者预后需要多种方法合理运用及多科室相互协作,在心搏骤停发生前后注意器官保护,减少器官损伤.

Extracorporeal cardiopulmonary resuscitation for adult patients with refractory cardiac arrest after cardiac surgery

Objective To summarize the clinical experiences of extracorporeal cardiopulmonary resuscitation （ ECPR）, which provides temporary eardiopulmonary assist, for adult patients with post - cardiotomy cardiac arrest. Methods From September 2004 to March 2013, 28 adult patients （21 males, 7 females） undergoing postoperative refractory cardiac arrest required ECPR support. Pa- tients＇mean age was 59.4 ± 11.5 years. The support duration of extracorporeal membrane oxygen （ECMO） was 115.5 ±68.2 hours. There were 23 patients （82.1% ） with coronary heart disease, 3 patients （10.7%） with cardiac valve disease, and 2 patients （7.1 % ） with congenital heart disease. All patients received venous - arterial ECMO. Results 18 patients （64.3%） successfully weaned from ECMO, 10 （35.7%） survived to hospital discharge, and 18 patients （64.3%） died. 25 patients （89%） were applied intra - aortic balloon pump （IABP） before ECPR. Multisystem and organ failure （MSOF） was the primary cause of death （10 patients, 35. 7% ）. 16 patients （57.1%） developed bacterial infections during ECMO. Conclusion ECPR earl be used satisfactorily for partial eardiopulmonary support to resuscitate adult patients following refractory cardiac arrest after cardiac surgery. It is important to select suitable patients for ECPR. Considering ECPR for appropriate patients as early as possible during CPR contributes to an increased sur- vival rate. Improvement in outcomes of ECPR patients requires a muhidisciplinary approach to protect organ function and limit organ in- jury before and during cardiac support.