体外膜肺氧合治疗瓣膜手术后急性心脏功能衰竭

目的探讨体外膜肺氧合（ECMO）治疗瓣膜手术后急性心脏功能衰竭的经验。方法回顾心脏外科监护病房（ICU）收治的60例瓣膜手术后因急性心脏功能衰竭接受ECMO辅助的患者的临床资料。男38例,女22例；年龄15-74岁,平均年龄（51±14）岁；采用静脉-动脉（V-A）转流模式。结果43例（71.7%）成功脱离ECMO,35例（58.3%）痊愈出院。平均ECMO辅助时间59h,平均监护室停留时间4d。主要并发症为出血19例、感染7例、肾功能衰竭需要透析15例、氧合器血浆渗漏18例、肢体缺血3例。结论ECMO是治疗瓣膜手术后急性心脏功能衰竭的一种有效的机械辅助方法,及时安装并积极防治并发症可降低病死率。

Extracorporeal membrane oxygenation support in acute heart function failure patients after valvular operation

Objective To investigate the treatment experience of extracorporeal membrane oxygenation （ECMO） support in acute heart function failure patients after valvular operation. Methods Retrospectively analyze the clinical data of 60 patients underwent valvular operation supported with ECMO in cardiac intensive care unit from September 2005 to January 2008. The cardiac operations included mitral valve replacement/repair（ n = 10）, aortic valve replacement（ n = 10）, double valvular replacement （ n = 4）, mitral/aortic valve replacement plus tricuspid repair （ n = 9）, valvular operation plus coronary artery bypass grafting （n = 6）, valvular operation plus intraoperative radiofrequency ablation of atrial fibrillation （n=21）. ECMO was established by cannulation of the right atrium and femoral artery for acute heart function failure. Heparin was infused to maintain the whole blood activated coagulation time （.ACT） of 160 to 200 seconds in centrifugal pump（35 cases）, and 200 to 250 seconds in roller pump（ 1 cases） to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 7 patients and continuous renal replacement therapy in 15 cases. Results 43 （71.7%）patients were successfully weaned from ECMO. 35 （58.3%） patients survived to discharge. Mean ECMO duration was 59 hours （range 1 to 206 hours） and the mean duration of ICU stay was 4 days（range 1 to 19 days）. The most common complications were re-exploration for bleeding （ n = 10） and alimentary tract hemorrhageand （ n = 9）, renal failure required renal replacement therapy （ n = 15 ）, infection （ n = 7 ）, plasma leak of oxygenators （ n = 15） ,limb ischemia （ n = 3 ）. Conclusion ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure in patients after valvular operation, but the prognosis depended on the original disease. Earlier institution of ECMO and prevent complication may improve outco