成人体外膜肺氧合循环支持19例

Clinical analysis of 19 adult heart failure patients with extracorporeal membrane oxygenation

目的总结成人临床应用体外膜肺氧合(ECMO)的经验、教训。方法 2004年12月至2006年4月对19例成人实施 ECMO,男14例,女5例;年龄19～72岁,平均48.8岁;体重37～100 kg,平均69.2 kg。内科急性心肺衰竭4例,术后心肺衰竭15例。使用 Medtronic 成人 ECMO 配套系统,经股动、静脉插管行心肺辅助。结果 10例(52.6%)顺利出院,9例(47.4%)死亡,其中6例未能脱机,ECMO 成功脱机13例(68.4%),其中3例脱机后未能得到进一步有效治疗而死亡。ECMO 支持11～196 h,平均83.3h。单一膜肺使用寿命40～134h。结论 ECMO 可以作为临床难治性心肺衰竭的有效辅助手段,使危重症病人度过危险期,为进一步治疗争取宝贵的时间。

Objective To analyze retrospectively adult patients undergoing extracorporeal membrane oxygenation （ECMO） in Fuwai Hospital. Methods We reviewed 19 adult patients （ 14 males, 5 females） with heart and lung failure treated with ECMO from Dec, 2004 to Apr ,2006. The median age was 48.8 years （19 to 72 years）, and the median body weight was 69.2 kg （37 to 100 kg）. There were 4 patients from internal medicine ward, 15 patients after open heart surgery. In all patients veno-arterial ECMO was instituted using Medtronic adult ECMO heparin-coated circuits. Results 13 of 19 patients （68.4%） successfully weaned from ECMO support, 10 （52.6%） survived to hospital discharge, and9 （47.4%） died. The average ECMO time was 83.3 h （11 to 196h）, the shortest time using single ECMO circuit was 40 h and the longest was 134 h. Conclusion ECMO is an effective mechanical assistant method for clinical patients with heart and lung failure, it can buy time to recovery of cardiopulmonary function or transfer to heart or lung transplantation.