体外膜肺氧合在成人暴发性心肌炎中的应用

Application of extracorporeal membrane oxygenation in adult fulminant myocarditis

目的:探讨体外膜肺氧合(ECMO)在成人暴发性心肌炎的治疗中的临床效果。方法:收集武汉大学人民医院心血管外科2015年4月1日至2018年12月1日间收治的暴发性心肌炎患者18例进行回顾性分析。所有患者入院时均有心源性休克,常规治疗方案无明显效果,遂急诊行ECMO辅助治疗(ECMO模式为VA,即静脉动脉模式)。观察患者术后恢复情况,对比患者入院时与ECMO撤机后的超敏肌钙蛋白I、氨基末端脑钠肽前体(NT-proBNP)、天冬氨酸氨基转移酶(AST)、血肌酐、纤维蛋白原(FIB)、乳酸脱氢酶(LDH)、乳酸、左室射血分数(LVEF)。结果:ECMO辅助治疗后患者心功能、肝肾功能、凝血功能、全身器官灌注等各项指标均有明显好转,恢复正常值左右。结论:体外膜肺氧合作为一种源于体外循环的新技术,是成人暴发性心肌炎的有效急救方案,对患者的恢复及预后有良好的效果。

Objective:To investigate the clinical effect of extracorporeal membrane oxygenation(ECMO)in the treatment of adult fulminant myocarditis.Methods:A retrospective analysis of 18 patients with ful-minant myocarditis admitted to the Department of Cardiovascular Surgery,Renmin Hospital Wuhan University from April 1,2015 to December 1,2018.All patients had cardiogenic shock when they were admitted to the hospital.As no obvious effect were found after conventional treatment,the pa-tients received emergency ECMO adjuvant therapy in venous artery(VA)mode.Clincal outcomes,the levels of hypersensitive troponin I,N terminal pro B type natriuretic peptide,aspartate aminotrans-ferase(AST),serum creatinine,fibrinogen,lactate dehydrogenase,lactic acid,and left ventricular ejection fraction were recorded on admission and after ECMO withdrawal.Results:After ECMO ad-juvant therapy,the indexes of heart function,hepatic and renal function,coagulation function,and systemic organ perfusion were all improved and returned to the normal levels.Conclusion:Extracor-poreal membrane oxygenation is a new technology derived from extracorporeal circulation and is an ef-fective first aid program for adult fulminant myocarditis.It has a good effect on the recovery and prog-nosis of patients.