体外膜肺氧合支持下治疗暴发型心肌炎

Treatment of Patients With Fulminant Myocarditis Supported by Extracorporeal Membrane Oxygenation

目的:回顾性总结分析我院7例暴发性心肌炎(FM)体外膜肺氧合(ECMO)支持下治疗的临床结果和经验。方法:2003年4月～2006年7月共实施ECMO支持下治疗FM病例7例。均在充分的药物治疗基础上,行静脉—动脉ECMO辅助支持,ECMO支持时间14～82小时,平均28小时,辅助期间平均血流量在20～70 ml/(kg·min)。结果:6例使用ECMO后血氧饱和度、血压及左心室射血分数较上ECOM前均明显提高,心肌型肌酸激酶MB同工酶显著降低,顺利撤离ECMO且康复出院,1例患者应用ECMO支持后血压、血氧饱和度、心律均有好转,但很快出现多器官功能衰竭,14小时后死亡。结论:FM常规药物治疗疗效不明显时,尽早使用ECMO辅助支持,对于可逆性心脏泵功能衰竭病人的恢复有良好效果,可以推荐为FM的一线支持治疗方法。

Objective： To retrospectively analyze and summarize the clinical experience and results of 7 patients with fulminant myocarditis （ FM ） treated with the support of extracorporeal membrane oxygenation （ECMO） in our hospital. Methods ： We systemically analyzed 7 FM patients admitted to our hospital from April 2003 to July 2006 before and after the treatment by ECMO support. All the 7 patients received conventional medication coupled with ECMO support. Vein-artery ECMO mode was applied to the patients with the mean blood flow of 20-70 ml/ （kg·min） during ECMO assisting period for 14-82 hours ,with mean time being 28 hours. Results： By using ECMO support ,6 patients had their blood oxygen saturation, blood pressure and left ventricle ejection fraction were significantly increased, and their myocardial enzymes,troponin T, and C reaction protein were obviously decreased. ECMO support was successfully weaned off and the patients were discharged alive. One patient died of multiple organ dysfunction syndrome 14 hours after ECMO support even though the patient＇s hemodynamic conditions were improved. Conclusions ： ECMO support should be applied as soon as possible when conventional medication was not effective in FM patients. ECMO is an effective mechanical assisting therapy for FM with reversible heart failure. It can be recommended as the first-line supporting treatment of FM in clinical practice.