体外膜式氧合治疗心脏术后急性心肺功能衰竭

Extracorporeal membrane oxygenation support in acute cardiorespiratory function failure patients after cardiac surgery

目的探讨体外膜式氧合（ECMO）治疗心脏术后急性心肺功能衰竭的经验。方法回顾性分析2005年3月至2008年6月心脏术后接受ECMO辅助的117例患者的临床资料。男性85例，女性32例，平均年龄（48．7±16．5）岁。其中80例患者因术中无法脱离心肺转流、35例因术后急性心脏功能衰竭进行静脉-动脉转流，2例因术后急性呼吸功能衰竭进行静脉-静脉转流。结果平均ECMO辅助时间61h，平均监护室停留时间5d。87例（74．4％）成功脱离ECMO，69例（59．0％）痊愈。主要并发症为出血38例、感染32例、。肾功能衰竭需要透析29例、氧合器血浆渗漏29例、溶血7例、肢体血栓5例、神经系统并发症4例。结论ECMO是一种有效的短期机械辅助方法，应掌握适应证尽早建立，积极防治并发症可降低死亡率。

Objective To investigate the treatment experience of extracorporeal membrane oxygenation （ECMO） support after cardiac surgery. Methods Retrospectively analyze the clinical data of 117 postoperative patients supported with ECMO in cardiac intensive care unit from March 2005 to June 2008. There were 32 female and 85 male patients, with a mean age of （ 48. 7 ± 16. 5 ） years old. The cardiac operations included coronary artery bypass grafting （ n = 20 ） , coronary artery bypass grafting and remolding of left ventricle （ n = 9 ） , coronary artery bypass grafting and valvular operation （ n = 5 ） , repair of ventricular septal perforation following acute myocardial infarction （ n = 2 ）, valvular operation （ n = 46 ）, heart transplantation （ n = 20 ）, lung heart transplantation and repair of ventricular septal defect （ n = 1 ）, correction of congenital heart defects （n = 10） ,aortic operations （n =4）. Venoarterial bypass was instituted in 115 for hemodynamic failure and venovenous in 2 patient for hypoxemia following cardiac surgery. ECMO was established in 110 patients by cannulation of the right atrium and femoral artery, and 5 of the right atrium and ascending aorta. And 2 case added left atrial drainage to ECMO. Heparin was infused to maintain the whole blood activated coagulation time （ACT） of 160 to 200 s in centrifugal pump （ 14 cases）, and 200 to 250 s in roller pump （3 cases ） to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 15 patients and continuous renal replacement therapy in 29 cases. Results Mean ECMO duration was 61 h （ranged 3 to 225 h） and the mean duration of ICU stay was 5 d. 87 patients （74.4%） were successfully weaned from ECMO. 69 patients （59. 0% ） survived to discharge. The most common complications were re-exploration for bleeding （n = 24 ） and alimentary tract hemorrhageand （ n = 14 ） , renal failure required renal replacement therapy （ n = 29 ） , infection （ n = 32 ） , limb ischemia （n =5）, plasma leak of oxygcnators （n = 29）, hacmatolysis （n = 7 ）, neurological complication （n = 4 ）. Conclusions ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure. Indication should be controlled strictly. Earlier institution of ECMO and prevent complication may improve outcome.