体外膜肺氧合在心肺辅助循环中的应用

Application of ECMO in cardiopulmonary failure support

目的 总结7例体外膜肺氧合（ECMO）在心肺辅助循环中的临床应用.方法 自2007年12月至2010年10月,对7例重症心肺功能衰竭患者进行ECMO支持治疗,所有患者均采用静脉-动脉插管行ECMO支持治疗,期间维持血流动力学和呼吸指标稳定.结果 ECMO支持时间20～48 h,平均32 h,患者建立ECMO后血流动力学及气体交换均有明显好转.其中5例患者顺利脱机,不能脱机的2例中1例在血管活性药物用量较大,ECMO流量较大的情况下仅能维持较低血压,而后心跳停止不能恢复.1例因患者肺受损严重,ECMO治疗效果不佳,肾功能衰竭,最后放弃治疗.结论 ECMO是救治心功能衰竭、呼吸功能衰竭的重要心肺辅助循环的有效手段.正确掌握其适应证、选择转流方式、良好的管理才能提高ECMO的成功率.

Objective observe the application of ECMO（extracorporeal membrane oxygenation） in cardiopulmonary failure support and summarize clinical experience. Methods gave ECMO treatment to 7 patients suffering from severe cardiopulmonary failure from December 2007 to October 2010. All the 7 patients received intravenous-arterial cannula ECMO support treatment and maintained stable hemodynamic and respiratory indexes. Results ECMO support time：20-48h,32h on average. With ECMO support, hemodynamics and respiration were significantly improved. 5 patients needed no longer to receive equipment treatment. One of the remained two patients used great amount of vasoactive drugs so that low blood pressure could be maintained with large ECMO flow. After that,cardiac arrest occurred and can not be restored. Poor effect was achieved for 1 patient due to severe lung damage. In addition,the patient also suffered from renal failure. Finally,the treatment was abandoned. Conclusion ECMO is an effective means for heart failure and respiratory failure treatment for cardiopulmonary circulatory support. With proper understanding of its indication and selecting the correct bypass way,ECMO success rate can then be improved.