体外膜肺氧合治疗急性爆发性心肌炎的临床观察

Extracorporeal membrane oxygenation for acutefulminant myocarditis

目的观察体外膜肺氧合（ECMO）治疗急性爆发性心肌炎的临床疗效。方法回顾性分析2013年5月至2014年11月南方医科大学顺德第一人民医院重症医学科经ECMO治疗的急性爆发性心肌炎患者临床资料。结果 4例患者均表现为难治性心源性休克,3例合并恶性心律失常,2例合并心跳骤停,药物治疗效果不佳。经ECMO（V-A模式）支持78~183 h后,血流动力学稳定性首先得到改善,然后是心肌损伤标志物（肌钙蛋白I、肌酸肌酶同工酶）明显下降,随后是心脏收缩功能改善,最后是脑利钠肽下降。临床转归：4例均成功撤机,生存出院;出院后恢复良好,在8~17个月的随访中未发现慢性心衰、心脏扩大、严重心律失常,恢复正常生活、学习、工作。并发症方面：2例发生氧合器血浆渗漏,2例置管部位出血,2例股动脉血栓,1例大隐静脉血栓。结论 ECMO是降低爆发性心肌炎患者早期病死率,改善长期预后的有效手段,应尽早启动。另外肌钙蛋白I在评估撤机时机具有潜在价值。

Objective To observe the clinical effect of extracorporeal membrane oxygenation（ECMO） for patients with acute fulminant myocarditis.Methods Patients with acute fulminant myocarditis received ECMO treatment in intensive care unit of the First People＇s Hospital of Shunde from May 2013 to November 20f4 were retrospectively analyzed.Results Refractory cardiogenic shock occurred in 4 patients.Malignant arrhythmia were complicated in 3 patients,cardiac arrest in 2 patients and medical therapy had no effect.After ECMO support for 78 to 183 hours,hemodynamics improved,myocardial damage markers（Creatine Kinase-MB,Cardiac Troponin I） decreased,cardiac systolic function improved and brain natriuretic peptide decreased.Plasma leakage on oxygenator occurred in 2 patients,hemorrhage at the catheterization site occurred in 2 patients,femoral arterial thrombosis occurred in 2 patients,thrombosis in great saphenous vein occurred in 1 patient.Four patients weaned ECMO support and survived to hospital discharge.They recovered well to daily lives,studies and work without chronic heart failure,cardiac dilatation ornialignant arrhythmia during the follow-up period of 7 months out to 18 months.Conclusions ECMO is an effective approach which reduces acute phase mortality,improves long-term prognosis in patients with acute fulminant myocarditis and should be used early.CTnlhas thepotential value inthe evaluation ofweaning of ECMO.