瓣膜手术后急性心脏功能衰竭体外膜式氧合治疗

Extracorporeal membrane oxygenation support for acute heart function failure in patients after valvular operation

目的:探讨体外膜式氧合(ECMO)治疗瓣膜手术后急性心脏功能衰竭的经验。方法:回顾2005年9月至2009年7月期间,我院心脏外科监护病房(ICU)收治70例瓣膜手术后因急性心脏功能衰竭接受ECMO辅助的患者的临床资料。男性43例,女性27例,年龄15～74岁,平均(53±12)岁,采用静脉-动脉(V-A)转流模式。结果:46例(65.7%)成功脱离ECMO,38例(54.3%)痊愈出院。平均ECMO辅助中位数时间59(1,206)h,平均监护室停留中位数时间4(1,19)d。主要并发症为出血21(30.0%)例,感染9(12.8%)例,肾功能衰竭需要透析17(24.2%)例,氧合器血浆渗漏20(28.5%)例及肢体缺血3(4.2%)例。结论:ECMO是治疗瓣膜手术后急性心脏功能衰竭的一种有效的机械辅助方法,及时安装并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 for acute heart function failure in patients after valvular operation.Methods：Retrospectively analyze the clinical data of 70 patients underwent valvular operation supported with ECMO in cardiac intensive care unit from September 2005 to July 2009.The cardiac operations included mitral valve replacement/repair（n = 13）,aortic valve replacement（n = 10）,double valvular replacement（n = 6）,mitral/aortic valve replacement plus tricuspid repair（n = 10）,valvular operation plus coronary artery bypass grafting（n = 7）,valvular operation plus intraoperative radiofrequency ablation of atrial fibrillation（n = 23）,mitral valve replacement plus atrial septal defect repair（n = 1）.ECMO was established by cannulation of the femoral venus and femoral artery.Heparin was infused to maintain the whole blood activated coagulation time（ACT） at 160 to 200 seconds in centrifugal pump（69 cases）,and 200 to 250 seconds in roller pump（1 cases） to avoid thrombotic events.This was administered until decannulation.Intra-aortic balloon pump was used in 10（14.2%） patients and continuous renal replacement therapy in 16（22.8%） cases.Results：46（65.7%） patients were successfully weaned from ECMO.38（54.3%） patients survived to discharge.Mean ECMO duration was 5（rang 1 to 206 hours） hours and the mean duration of ICU stay was 4 days（rang 1 to 19 days）.The most common complications were re-exploration for bleeding（n = 12,17.1%） and alimentary tract hemorrhageand（n = 9,12.8%）,renal failure required renal replacement therapy（n = 17,24.2%）,infection（n =9,12.8%）,plasma leak of oxygenators（n =20,28.5%）,limb ischemia（n =3,4.2%）.Conclusion：ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure in patients after valvular operation,but the prognosis depended on the original disease.Earlier usage of ECMO and prevent complication may improve outcome.