体外膜肺氧合在危重心肺疾患的临床应用体会

Clinical application of extracorporeal membrane oxygenation in patients with severe cardiopulmonary disorders

目的总结危重心肺疾病患者实施体外膜肺氧合支持方法和效果。方法对5例患者实施体外膜肺氧合支持,年龄27～82岁(平均年龄47岁),体质量53～87kg(平均体质量69.6kg)。5例患者病因不同,分别为:例1,男性,29岁,爆炸伤,心肺功能衰竭;例2,男性,82岁,急性心肺功能衰竭;例3,女性,34岁,急性心源性休克复苏后支持;例4,男性,27岁,心脏外伤,心脏手术后低心排血量;例5,女性,63岁,联合瓣膜置换术后低心排血量。采用静脉-动脉转流,辅助流量40～70ml/(kg·min);间断检测激活凝血时间(ACT)160～200s。结果体外膜肺氧合支持时间22～61h(平均39.4h)。1例未能脱机而死亡,4例成功脱机,3例康复出院。结论体外膜肺氧合支持是抢救危重心肺功能衰竭及心脏手术心功能支持有效方法。

Objective To summarize the method and effect of extracorporeal membrane oxygenation （ECMO） on severe cardiopulmonary disorder patients. Methods The ECMO was performed in 5 patients, aged 27 - 82 years, mean age 47 years, body weight 53 - 87 kg（mean 69.6 kg）. The patients were supported with ECMO： 1.male, 29-year-old with explosive injury, heart failure, respiratory failure; 2. male, 82-year-old with acute heart failure, respiratory failure; 3.female, 34-year-old with cardiogenic shock, support with ECMO after cardiopulmonary resuscitation; 4.male, 27-year-old with cardiotrauma, low output syndrome postcardiac surgery; 5.female, 63-year-old, post double valve replacement. All of them were used vein-artery perfusion, the support perfusion flow varied from 40 to 70 milliliter per kilogram per minute; during ECMO, their activated clotting time （ACT） were kept 160 - 200 seconds. Results The ECMO perfusing time varied from 22 hours to 61 hours（mean 39.4 hours）; 1 patient didn＇t weaned from ECMO until death, 4 patients were succeed to wean from ECMO and 3 patients were rehabilitated and discharged. Conclusion Extrocorporeal membrane oxygenation is an effective emerging approach to manage cardiopulmonary function failure and support heart function during cardiosurgery.