超声心动图在体外膜肺氧合对心脏支持的应用价值

Evaluation of Echocardiography in Extracorporeal Membrane Oxygenation Support for Heart Disease

目的：探讨超声心动图在体外膜肺氧合(ECMO)支持辅助中对心脏的监测作用。方法：2004年12月～2005年8月间连续10例因低心排接受 Veno-Aterial ECMO 支持,其中心脏外科术后8例,心肌病急性心力衰竭拟心脏移植的2例患者,年龄13～60岁,平均(44±12)岁。仪器为 Philips iE33和 sonos 5500彩超仪,均在床旁进行检查,分别在 ECMO 安置前、ECMO 辅助后(撤机前30 min 内流量减至最低)前后观察患者左心室射血分数(INEF)、左心室舒张末前后径(LVEDD)等指标,结合患者临床资料(心率、血压、左心房压及血氧饱和度)对比。并观察并发症情况。结果：10例患者 ECMO 辅助后的 LVEF、LVEDD、心率、血压、左心房压及动脉血氧饱和度均有改善。并发症的检出：机械瓣异常、左心房血栓、心包血凝块、二尖瓣狭窄未纠正各1例。结论：彩色多普勒超声心动图可无创实时评价 ECMO 辅助前后心脏结构及功能变化,及时发现其并发症。

Objective： To explore the monitoring value of echocardiography in patients using extracorporeal membrane oxygenation （ECMO） for cardiac support. Methods：Over an 8-month period from December 2004 to August 2005, a total of 10 consecutive cardiac patients （ M = 6, F = 4） received veno-aterial ECMO support o Among them, 8 had undergone cardiac surgery and 2 were waiting for heart transplantation due to acute heart failure. Cardiac structure and function were evaluated by echocardiography at bedside before and af- ter veno-atefial ECMO support. Results：All patients were improved after ECMO in left ventricular ejection fraction （25 ± 12.9% vs 36. 6 ± 19. 2%, P 〈 0.05） ,BP,heart rate,left atrium pressure,SaO2 and left ventricular end diastolic diameter（60. 7 ± 12.2mm vs 57.8 ± 10. lmm, P 〉 0.05 ）. There were complications ： one of left atrium thrombus, one artificial valve abnormality, one pericardial clot and one mitral valve restenosis. Conclusion： Echocardiography could evaluate cardiac structure, ventricular function and other abnormality in patients with ECMO support.