体外膜肺氧合在抢救危重心脏病患者心搏骤停中的作用

Effects of extracorporeal membrane oxygenation on resuscitation in cardiac arrest patients

目的 观察体外膜肺氧合对危重心脏患者心搏骤停后常规心肺复苏困难者的治疗效果。方法 本院自2005年9月至2006年5月行体外膜肺氧合（ECMO）治疗危重心脏病患者37例，回顾性分析其中11例发生心搏骤停实施常规心肺复苏无效或复苏后持续低心排而行ECMO循环辅助患者的病历资料。结果 5例为心脏术后患者，其中3例心肺复苏（CPR）的同时紧急建立体外循环再次手术，之后因低心排而行ECMO。7例患者床旁建立ECMO，ECMO支持治疗（134．0±113．0）h。8例顺利停机，6例存活出院，其中2例经心脏移植后出院。3例不能顺利脱机者由于ECMO辅助期间循环功能恶化，并最终死于多器官功能衰竭。ECMO期间出现的并发症包括出血、神经精神系统异常、肢体缺血坏死和多脏器功能不全。结论 ECMO可以为心搏骤停的患者提供最快的心肺功能支持，为赢得抢救时机和提高抢救质量提供了又一途径，在危重患者心肺复苏中具有良好的疗效。

Objective To observe the effects of emergency extraeorporeal membrane oxygenation （ECMO） following eardiopalmonary resuscitation （CPR） in patients with cardiac arrest. Method The data of 11 cardiac arrest patients who received CPR before ECMO from September 2005 to May 2006 at our hospital were studied retrospectively. Candidates for ECMO resuscitation were those who didn＇t respond to CPR or who returned to spontaneous circulation with persistent heart failure and needed ECMO support urgently after CPR. Results Five patients underwent cardiac operation before cardiac arrest, and among them 3 underwent emergency re-operation after CPR. Seven patients received ECMO outside operation room. The mean duration of ECMO was （134.0±113.0） h. Eight patients were successfully weaned from ECMO, six patients survived and discharged at last, and among them, 2 received heart transplantation. The complications during ECMO included bleeding, renal failure, neurological e abnormality and infection. Conclusions ECMO was kind of technique which could be set up quickly and provide eardiopulmonary support for patients without good response to CPR during emergency situation. The application of ECMO in CPR improved the outcome of patients with serious heart disease.