体外膜肺氧合在抢救危重心脏病心脏危象患者中的应用

The effects of extracorporeal membrane oxygenation in severe cardiopaths with crisis

目的探讨体外膜肺氧合（ECMO）在危重心脏病心脏危象患者中的应用价值。方法选择行ECMO辅助治疗的危重心脏病心脏危象患者14例，其中暴发型心肌炎合并室性心律失常、急性心力衰竭和（或）心源性休克8例，急性心肌梗死合并泵衰竭或心源性休克6例。采用股动脉、股静脉插管技术，静脉动脉．ECMO辅助治疗。监测ECMO辅助治疗前后心脏血流动力学及血气分析等指标。结果行ECMO辅助治疗后，患者平均动脉压（MAP）迅速升高，左室射血分数（LVEF）改善，左室舒张末期内径（LVEDd）有所缩小，动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）较建立ECMO前明显升高（P〈0．05或〈0．01），剩余碱（BE）负值明显降低（P〈0．01）。撤机前2h与撤机后24hMAP比较差异无统计学意义[（80．02±10．20）mmHg（1mmHg=0．133kPa）比（76．34±9．15）mmHg]（P〉0．05），而LVEF、LVEDd继续好转（P〈0．05）。结论ECMO可为危重心脏病心脏危象患者提供一定的氧供及稳定的循环血量，维持重要脏器功能，为心肺功能的恢复或原发病的治疗赢得时间。

Objective To investigate the effects of extracorporeal membrane oxygenation （ECMO） in severe cardiopaths with crisis. Methods Fourteen cases of severe cardiopaths with crisis were treated by ECMO with V A- ECMO technique, whose pump was centrifugal pump and whose tubes was spread by heparin. The cases included 8 fulminating myocarditis （FM） cases with ventricular arrhythmias or/and acute heart failure or/and cardiac shock and 6 acute myocardial infarction cases with pump failure or cardiac shock, in whom 10 cases with cardiorespiratory resuscitation. Haemodynamics and blood gas analysis, and so on were measured before and after treatment. Results The support time of ECMO was 3-106 h, mean （32.4 ± 27.6） h. After ECMO mean arterial blood pressure （MAP）, left ventricular ejection fraction （LVEF）, left ventricular end-diastolic dimension （LVEDd）, partial pressure of arterial oxygen, saturation of blood oxygen improved （P 〈 0.05 or 〈 0.01 ）, negative value of base excess decreased significantly（ P 〈 0.01 ）. MAP had not changed before and after stopping ECMO [ （80.02 ± 10.20） mm Hg （ 1 mm Hg = 0.133 kPa） vs （76.34 ± 9.15） mm Hg] （P 〉0.05）, however, LVEF and LVEDd improved continually （P 〈0.05）. Conclusion ECMO can provide oxygen supply and stable circulation volume for severe cardiopaths with crisis to recover cardiorespiratory function or save valuable time to treat primary disease.