急诊体外循环抢救心血管危重患者的临床应用

The clinical use of emergency extracorporeal circulation on emergency treatment of imminent patients

目的临床评价急诊体外循环(ECC)抢救和治疗危重患者的效果。方法 1999年10月到2011年3月应用ECC抢救和治疗危重患者86例,其中男57例,女29例,年龄0.5个月～80岁,平均26.0岁。体重4.0～86 kg,平均38.2 kg。其中在ICU或病房发生心搏骤停6例;在手术室或介入导管室发生心搏骤停5例;急诊冠状动脉旁路移植术(CABG)15例;介入封堵治疗时发生意外5例;术中发生心脏、大血管损伤9例;婴幼儿术前心衰、肺炎、呼吸困难需急诊手术8例,其中3例术前行气管插管、呼吸机控制呼吸;术前因法洛四联症缺氧发作6例;介入治疗时发生医源性心脏、大血管损伤6例;感染性心内膜炎急诊手术4例;左房黏液瘤堵塞二尖瓣口3例;心血管术后因左房、左室破裂、右室出血、残留瓣组织影响人工瓣活动等19例。急诊ECC方法:浅低温64例,中低温15例,左心辅助转流4例,深低温低流量3例。经股-股ECC 5例,主动脉和左房插管行左心转流4例,常规插管急诊ECC 77例。结果 86例中成活79例(成活率为91.86%);术后随访1个月～8年,生存良好。结论尽早建立和改良急诊ECC技术,加强围术期处理,可提高抢救心血管危重患者的成功率。

Objective To evaluate the effect of emergency extracorporeal circulation on emergency treatment of imminent pa- tients. Methods Total 86 imminent patients, included 57 male and 29 female, aged from 0.5 month to 80 years （ mean 26）, under- went emergency extracorporeal circulation. Among these patients, 11 suffered from sudden cardiac arrest （ included 6 occurred in ICU or wards and 5 in operating room or during interventional treatment）, 15 underwent emergency coronary artery bypass graft, 5 suffered from emergency during interventional occlusion of ventricular septal defect, 6 suffered from iatrogenic injury in heart or great vessel oc- curred during interventional treatment, and 9 from heart or great vessel injury during operation, 8 infants underwent emergency opera- tion because of congestive heart failure, pneumonia or dyspnea （ included 3 infants underwent tracheal intubation and ventilatory sup- port）, 6 tetralogy of Fallot patients suffered from anoxic blue spells. 4 infective endocarditis patients needed emergency operation, 3 suffered from left atrial myoxoma and the myoxoma obstructed the mitral orifice and other 19 patients because of some other reasons, such as rapture of left atrium or ventricle, bleeding in right ventricle, residual valvular tissue which impede opening and closing of arti- ficial valve, etc. Emergency extracorporeal circulation methods included sub -hypothermia in 64, moderate hypothermia in 15, cor sinistrum aid bypass in 4 and profound hypothermia and low flow in 3 patients. Results There were 79 patients survived （ survival rate was 91.86% ）. Following up from 1 month to 8 years in 79 survival and they are all lived well. Conclusion Establishing emergency extracorporeal circulation as early as possible, improving the emergency extracorporeal circulation technique and intensive treatment be- fore and after operation can improve the survival rate of emergency treatment of imminent patients.