先天性心脏病体外循环术后110例心肺脑复苏的研究

Study of 110 cases of cardiopulmonary cerebral resuscitation after cardiopulmonary bypass surgery

目的总结先天性心脏病(先心病)体外循环(CPB)术后引起心跳呼吸骤停(CRA)的常见原因,探讨心肺脑复苏(CPCR)的策略、方法 ,并介绍成功经验,为进一步提高复苏成功率提供依据。方法回顾分析2005年1月至2009年12月阜外心血管病医院小儿心脏中心CPB术后发生的110例CRA病例,对诱因、CPCR开始时间及主要方法、相关因素对初步复苏成功即自主循环恢复(ROSC)的影响、体外循环膜肺氧合(ECMO)的比例及预后等进行统计分析。结果全组初步复苏成功率51.8%,出院率40.9%。床旁开胸29例(存活6例),其中床旁行CPB 5例(全部死亡),ECMO 12例(顺利撤机7例、出院4例)。发现引起CPB术后CRA的主要原因为低氧血症44.5%、室颤23.6%、心电-机械分离(PEA)18.2%、心跳停搏10%、其他3.6%。分析初步复苏成功的相关因素,性别、年龄、体重、CRA发生时是否机械通气对ROSC的影响差异无显著性。循环诱因对初步复苏的成功与否有显著影响。结论先心病患儿CPB术后发生CRA的原因及复苏过程有其自身特点。本组初步复苏成功率较高与CRA的及时发现、病因的准确判断,复苏团队的训练有素及ROSC建立后的综合处理密切相关。合理应用ECMO技术可为提高CPCR的远期成功率起到积极作用。

OBJECTIVE To evaluate the factors associated with cardio-respiratory arrest（CRA） and to determine the effect of cardiopulmonary cerebral resuscitation（CPCR） after cardiopulmonary bypass（CPB） surgery.METHODS A retrospective analysis was reviewed of 110 patients received CPCR after the CPB surgery in recent five years.Causing of CRA,related factors of initial resuscitation and the ratio and result of extracorporeal membrane oxygenation（ECMO） were evaluated.RESULTSThe success rate of initial resuscitation was 51.8%,45 cases survived and discharged.29 cases were given bedside chest open,5 of them were followed by bedside CPB（no survived） and 12 by ECMO（4 of them survived and discharged）.Reasons related to CRA in this group were hypoxemia（44.5%）,ventricular fibrillation（23.6%）,pulseless electronic activity（PEA,18.2%）,asystolic（10%） and others（3.6%）.Sex,weight,age distribution and mechanical ventilated did not affect the success rate of initial resuscitation.Hemodynamic reasons were associated with restoration of spontaneous circulation（ROSC）.CONCLUSION The higher success rate of initial resuscitation in this group was benefit from the on time aware of CRA,correct determination of the causes of CRA,the well-trained resuscitation team and the comprehensive treatment after the establishment of ROSC.ECMO was useful for the initial resuscitation and the long-term result of CPCR.