体外膜肺氧合141例临床经验报道

Retrospective analysis of 141 patients managed by extracorporeal membrane ox ygenation in Beijing Anzhen Hospital

目的总结北京安贞医院141例心肺功能衰竭患者接受体外膜肺氧合（ECMO）辅助治疗的临床经验。方法2004年6月至2012年12月间，共计141例心肺功能衰竭接受ECMO辅助治疗，按照辅助结果，将患者分为出院存活组（SG，n=51）和死亡组（NG，n=90），比较两组患者ECMO辅助情况。结果98例（69．50％）患者成功脱机，5l例（36．17％）患者存活出院。ECMO辅助时间6～600（111．61±106．31）h。ECMO辅助前乳酸水平NG组患者（13．85±5．76）mmol／L较sG组患者（10．44±4．57）mmol／L高（P〈0．05）。ECMO辅助期间所需的最高流量NG组患者[（57．76±19．81）ml／（kg·min）]较SG组患者[（46．95±17．46）ml／（kg·min）]高（P〈0．05）。住院时间NG组患者（24．61±12．79）d明显较SG组患者（41．79±21．69）d短（P〈0．01）。结论ECMO是一种有效的循环辅助技术，尽早对心肺功能衰竭患者使用，避免重脏器不可逆损伤，将更有利于提高辅助成活率。

Objective To describe our experience with extracorporeal membrane oxygenation （ECMO） for cardiorespiratory support of 141 patients in Beijing Anzhen Hospital. Methods We retrospectively reviewed the medical files of 141 patients treated with ECMO for cardiorespiratory assistance because of acute and refractory cardiogenic shock at our institution from Jun. 2004 to Dec. 2012. The patients were divided into two groups defined by clinical outcomes （in- hospital death group, NG and survival to discharge group, SG）. Results Ninety - eight patients （69.50%） successfully weaned from ECMO and fifty - one patients （36.17%） sur- vived to discharge. The mean duration of ECMO support was 110.64 ± 84.96 （ range 1 to 600） hours. Compared with the survivor group, the nonsurvivor group had higher blood lactate level pre - ECMO, higher ECMO blood flow rate, and shorter hospital stay （ P 〈 0.05）. Conclusion ECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure. Earlier usage of EC- MO for heart or lung failure patients and avoiding the main organs from un - recovery trauma are still the key points of successful ECMO.