体外膜肺氧合在心脏移植术后移植物衰竭支持治疗中的应用

目的:总结心脏移植术后早期移植物衰竭体外膜肺氧合(extracorporeal membrane oxygena-tion,ECMO)支持治疗的临床经验。方法:自2008年1月至2011年12月,阜外医院共进行心脏移植181例,其中16例患者在心脏移植术后使用ECMO进行循环支持治疗。记录ECMO运行期间相关参数、机械辅助时间、并发症等指标。观察ECMO建立时、辅助24 h和撤机时患者血浆乳酸值,ECMO辅助前和ECMO辅助24 h多巴胺及肾上腺素的用量。结果:16例心脏移植围手术期接受ECMO支持治疗的患者中脱机14例(87.5%),存活出院13例(81.3%)。其中2例因心脏功能无改善不能脱机放弃治疗,1例脱机后发生慢性排斥反应,出现多器官功能衰竭(MOF)死亡。所有患者均采用动脉—静脉(A-V)ECMO辅助方式,患者ECMO前、ECMO运行24 h和停止ECMO时血浆乳酸值分别为:(8.36±3.41)、(2.42±1.53)、(2.25±2.17)mmol/L。运行24 h及停止ECMO时,血浆乳酸值较安装前明显下降(P<0.05)。ECMO前和运行24 h多巴胺用量分别为:(7.38±3.42)和(5.29±1.93)μg.min-1.kg-1,两者之间比较,差异无统计学意义(P>0.05)。ECMO前和运行24 h肾上腺素用量分别为:(0.17±0.11)和(0.02±0.03)μg.min-1.kg-1,运行24 h较ECMO前肾上腺素用量明显减小(P<0.05)。结论:ECMO是一种有效的循环呼吸衰竭辅助支持疗法,能明显降低终末期心脏病患者心脏移植术后早期病死率。

Extracorporeal membrane oxygenation for primary graft failure after heart transplantation

Objective:To analyze our results with extracorporeal membrane oxygenation(ECMO) support for primary graft failure in heart transplant recipients.Methods:181 heart transplantation cases,between January 2008 and December 2011,were retrospectively studied in Fuwai Hospital.Sixteen cases of them had received ECMO treatment after the transplantation.Data of the relevant parameters during ECMO,mechanism assistant duration and complications of the patients were collected.The level of lactic acid(LA) at the onset and 24 h of ECMO were measured.The dosage of dopamine and adrenergic pre and after 24 h of ECMO were recorded.Results: Fourteen patients(87.5%) were successfully weaned from ECMO and 13(81.3%) survived to hospital discharge.Among the 16 cases of ECMO,2 abandoned therapy for no cardiac function promotion was obtained.1 of them died of multiple organ failure(MOF) and chronic rejection were the main cause of death.All patients had received artery-vein(A-V) ECMO.The average level of LA at before,24 h and the end of ECMO were(8.36±3.41)、(2.42±1.53) and(2.25±2.17) mmol/L,respectively.LA was significantly decreased at the 24 h and the end of ECMO,compared with pre ECMO period(P <0.05).The dosage of dopamine pre and after 24 h of ECMO were(7.38±3.42)、(5.29±1.93) μg·min-1·kg-1,no significant differences were observed.However,after 24 h of ECMO,the dosage of adrenergic significantly decreased(0.17±0.11)、(0.02±0.03) μg·min-1·kg-1,P <0.05).Conclusion: ECMO is an effective mechanism support treatment for circulation and respiration failure.It could significantly decrease the perioperative mortality rate of the patients who were at the terminal stage of cardiac diseases and received heart transplantation.