体外膜肺氧合的术后并发症(附7例报告)

Syndrome of extracorporeal membrane oxygenation (ECMO): a report of 7 cases

目的总结和分析体外膜肺氧合(ECMO)的临床应用效果及并发症预防经验。方法心脏术后出现心脏功能和呼吸功能衰竭的患者7例,常规治疗无明显效果,予以ECMO辅助治疗,其中5例使用离心泵辅助,2例使用搏动泵辅助,同时应用多种血管活性药物治疗。结果应用ECMO辅助治疗后,7例患者中2例死于肺部感染,1例死于血栓形成,1例死于溶血导致的DIC,3例顺利恢复出院。术后其他并发症包括出血、右心功能衰竭、心律失常、低血压等,经治疗后均恢复。结论心脏外科手术后应严密观察患者的生命体征,如果出现心肺功能衰竭表现,应早期使用ECMO辅助。辅助开始后,应积极监测及预防并发症的发生,一旦出现并发症,应积极治疗以挽救患者生命。

Objective To summarize and analyze the experiences on clinical application of extracorporeal membrane oxygenation （ECMO）, and on the prevention of complications. Methods Seven patients, suffered from heart and respiratory failure after heart surgeries with no obvious curative effect by conventional therapy, were treated with ECMO adjunctively. Centrifugal pump assistant device was adopted for five cases, while the other two cases were treated with pulsated pump assistant device, and vasoacfive agents were used in all the seven cases. Results After using of ECMO, two cases died of pulmonary infection, one died of thrombosis, one died of disseminated intravascular coagulation （DIC） induced by hemolysis, and the other three eases were successfully recovered and discharged after treatment. Other complications included hemorrhage, right heart failure, arrhythmia and hypotension, etc. , and were recovered after treatment. Conclusions Clinical symptoms must be monitored after cardiac surgical operations, and ECMO should be used adjunctively once heart and/or respiratory failure appear. During the ECMO treatment, it is also import to prevent from the complications, once they occur, active therapies must be carried out to save the patients＇ lives.