体外膜肺氧合在心脏危重症患者救治中的应用

Application of extracorporeal membrane oxygenation for treatment of critically ill cardiac patients

目的：总结体外膜肺氧合（ECMO）辅助在心脏危重症患者中的临床救治经验与体会。方法：回顾性分析7例因药物治疗和／或主动脉内球囊反搏（IABP）无效而行ECMO辅助的心源性休克或血流动力学障碍患者的临床资料。ECMO辅助的主要原因：急性心肌梗死后心源性休克4例（57．1％），暴发性心肌炎1例（14．3％），心脏骤停2例（28．6％）。结果：7例患者ECMO平均辅助时间（4．7±3．2）d（范围：1～9d），6例（85．7％）顺利撤除ECMO，3例行经皮冠状动脉介入治疗。主要并发症包括：出血2例（28．6％），肢体缺血1例（14．3％），急性肾衰竭1例（14．3％），多器官功能衰竭2例（28．6％）。1例在ECMO辅助情况下放弃治疗死亡，2例在成功撤除ECMO后死亡。其中，1例死于严重出血，2例死于多器官功能衰竭。其余4例（57．1％）好转存活出院。结论：ECMO能暂时性为心肺功能提供有效的支持，有利于稳定心脏危重患者的血流动力学，为心功能的恢复创造机会，减少ECMO相关并发症的发生可能会改善心脏危重患者预后。

Objective： To summarize the clinical experience of treating critically ill cardiac patients with extracorporeal membrane oxygenation （ECMO） support. Methods： Clinical data of 7 patients supported with veno-arterial ECMO system because of refractory cardiogenic shock （CS） or unstable hemodynamic after failure of conventional therapy and intra-aortie balloon pump counterpulsation （IABP） therapy were analyzed retrospectively. Indications for support were post-acute myocardial infarction with CS （4 cases, 57.1% ） , fulminant myocarditis （ 1 case, 14.3% ） , and cardiac arrest （2 cases, 28.6% ）. Results ： Patients were supported with ECMO for a mean duration of （4.7 ± 3.2 ） days （ range ： 1 - 9 days）, and weaning was successful in 6 patients （85.7%）. Three patients had undergone percutaneous coronary intervention （PCI）. Major complications included bleeding （2 cases, 28.6% ）, limb ischemia （1 case, 14.3% ）, acute renal failure （1 case, t4.3% ）, and multiple organ failure （2 cases, 28.6% ）. One patient died while on ECMO support, 2 patients died after successfully weaned from ECMO, among them one died from severe bleeding and the other two died from multiple organ failure. The other 4 （57.1% ） cases were successfully weaned from ECMO and survived to discharge. Conclusions： Critically ill cardiac patients with an initial unstable hemodynamic status could benefit from ECMO support, which may be beneficial as a temporaly support for heart function or lung function, and subsequent leading to organ recovery. Attempts to reduce the occurence of complications might improve the prognosis of critically ill cardiac patients.