体外膜肺氧合在心脏移植术后早期移植物功能障碍中的应用

目的  分析体外膜肺氧合(ECMO)在心脏移植术后早期移植物功能障碍(EAD)中的应用效果。方法  回顾性分析614例心脏移植受者的临床资料，根据术后是否使用ECMO分为ECMO组(43例)和非ECMO组(571例)。总结ECMO组受者心脏移植术后ECMO支持治疗情况，比较两组受者的围手术期情况和远期预后。结果  43例ECMO支持受者中，17例因出血进行开胸探查，10例出现感染，4例出现下肢静脉血栓，1例出现脑卒中。26例受者成功脱离ECMO后康复出院，6例受者ECMO支持期间死亡，6例受者ECMO脱机后死亡，5例受者因无法脱离ECMO而接受再次移植，再次移植后仅1例存活。与非ECMO组比较，ECMO组术中体外循环时间较长，术后需要主动脉内球囊反搏(IABP)、肾功能不全需要透析、再次开胸止血、感染、机械通气时间≥96 h和气管切开比例较高，术后重症监护室(ICU)入住时间较长(均为P < 0.05)。ECMO组受者出院生存率和90 d生存率分别为63%和96%，低于非ECMO组的97%和100%，差异均有统计学意义(均为P < 0.05)。生存分析结果显示，ECMO组受者的远期生存率低于非ECMO组(P < 0.05); 当排除心脏移植术后90 d内死亡的受者后，两组之间的远期生存率差异无统计学意义(P > 0.05)。结论  ECMO是治疗心脏移植术后EAD有效的方法。使用ECMO的受者心脏移植术后的早期生存率低于不使用ECMO的受者，而顺利度过心脏移植术后90 d远期生存率差异无统计学意义。

Application of extracorporeal membrane oxygenation in early allograft dysfunction after heart transplantation

Objective To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on early allograft dysfunction (EAD) after heart transplantation. Methods Clinical data of 614 heart transplant recipients were retrospectively analyzed. All recipients were divided into the ECMO group (n=43) and non-ECMO group (n=571) according to postoperative application of ECMO. In the ECMO group, the conditions of recipients undergoing ECMO after heart transplantation were summarized. Perioperative status and long-term prognosis of recipients were compared between two groups. Results Among 43 recipients undergoing ECMO, 17 cases underwent thoracotomy due to bleeding, 10 cases of infection, 4 cases of venous thrombosis of the lower limbs, and 1 case of stroke, respectively. Twenty-six recipients were recovered and discharged after successful weaning from ECMO, six died during ECMO support, six died after weaning from ECMO, five received retransplantation due to unsuccessful weaning from ECMO, and only one survived after retransplantation. Compared with the non-ECMO group, intraoperative cardiopulmonary bypass duration was significantly longer, the proportion of recipients requiring postoperative intra-aortic balloon pump (IABP), dialysis due to renal insufficiency, reoperation for hemostasis, infection, mechanical ventilation time≥96 h and tracheotomy was significantly higher, and the length of postoperative intensive care unit (ICU) stay was significantly longer in the ECMO group (all P < 0.05). The survival rate after discharge and 90-d survival rate in the ECMO group were 63% and 96%, significantly lower than 97% and 100% in the non-ECMO group (both P < 0.05). Survival analysis showed that the long-term survival rate in the ECMO group was significantly lower than that in the non-ECMO group (P < 0.05). After excluding the recipients who died within 90 d after heart transplantation, no significant difference was observed in the long-term survival rate (P > 0.05). Conclusions ECMO is an effective treatment of EAD after heart transplantation. The short-term survival rate of recipients using ECMO after heart transplantation is lower than that of those who do not use ECMO, and there is no significant difference in long-term survival of recipients surviving 90 d after heart transplantation.