冠状动脉旁路移植术后体外膜肺氧合治疗严重低心排出量综合征

Extracorporeal membrane oxygenation support in severe low output syndrome patients after coronary artery bypass grafting

目的:探讨体外膜肺氧合(ECMO)治疗冠状动脉旁路移植术(CABG)术后,急性心脏功能衰竭的经验。方法:回顾2006年1月至2010年12月期间我院33例单纯CABG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26例,女性7例,平均年龄(59±11)岁,35～76岁。其中24例先行放置IABP,9例放置ECMO,ECMO辅助均采用静脉动脉(V-A)模式。结果:21例(63.6%)成功脱离ECMO,13例(39.4%)痊愈出院。平均ECMO辅助时间55h,平均监护室停留时间6 d。主要并发症为感染12例、肾衰竭需要透析11例、氧合器血浆渗漏10例、出血6例、肢体缺血5例、神经系统并发症2例。结论:ECMO是一种有效的治疗CABG术后急性心脏功能衰竭的短期机械辅助方法,及时放置并积极防治并发症可改善预后。

Objective：To investigate the treatment experience of extracorporeal membrane oxygenation （ECMO） support in severe low output syndrome patients after coronary artery bypass grafting. Methods： Retro- spectively analyze the clinical data of 33 patients[ 7 female ,26 male, mean age（59±11 ）years] supported with ECMO for acute heart function failure following CABG from January 2006 to December 2010. Venoarterial by- pass was instituted in all patients for hemodynamic failure. ECMO was established in 31 patients by cannulation of the right atrium and femoral artery, and 2 of the right atrium and ascending aorta. Heparin was infused to maintain the whole blood activated coagulation time （ACT） of 160 to 200 seconds to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 22 patients and continuous re- nal replacement therapy in I I cases. Results： 21 （63.6%）patients were successfully weaned from ECMO. 13 （39. 4% ）patients survived to discharge. Mean ECMO duration was55 hours （range 9 to 144 hours） and the mean duration of ICU stay was 6 days. The most common complications were infection（ n = 12） ,renal failure re- quired renal replacement therapy （n = 11 ）, plasma leak of oxygenators （n = 15 ）, re-exploration for bleeding （n = 3 ） and alimentary tract hemorrhageand （ n = 3 ） , limb ischemia （ n = 5 ） , neurological complication （ n = 2 ）. Conclusion： ECMO is an effective mechanical assistance method for short-term treatment of acute heart function failure patients after coronary artery bypass grafting. Earlier institution of ECMO and prevent complication may improve outcome.