ECMO技术在成人体外心肺复苏中的效果分析

Outcome analysis of ECMO applying in extracorporeal cardiopulmonary resuscitation in adult cardiac arrest patients

目的总结单中心运用体外膜肺氧合（ECMO）为体外心肺复苏（ECPR）手段救治心脏骤停患者的效果，探讨心脏骤停患者救治新思路。方法回顾性分析阜外医院2005年7月至2014年9月，运用ECMO实施ECPR的17例患者的病历资料。比较生存组与死亡组心肺复苏（CPR）时间、ECMO辅助时间等各参数差异。结果全组CPR抢救（44．53±21．39）min，ECMO循环辅助（106．384-70．43）h，12例成功撤离辅助，6例患者生存出院。ECMO辅助前最后1次血肌酐、血乳酸、乳酸恢复正常时间差异有统计学意义（均P〈0．05）。发生院内死亡11例，7例合并出血，8例合并感染。结论ECMO作为ECPR技术手段能适当提高心脏骤停患者的抢救成功率，ECMO辅助前的血肌酐、乳酸水平以及乳酸恢复正常时间可能是判断预后的重要指标。无法恢复有效循环和神经系统并发症是影响救治成功率的重要因素。

Objective Summarizing single clinical experience with extracorporeal membrane oxygenation（ECMO） as a supplement to extracorporeal cardiopulmonary resuscitation（ECPR） in adult patients with cardiac arrest to explore new ideas. Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital, and analyzed the differences between the survival group （n = 6 ） and the in-hospital death group. Results The mean CPR time was（44.53 ~21.39） min. The support duration of ECMO was（106.38±70.43） h. 12 patients of all were successfully weaned from ECMO, and 6 patients survived to hospital discharge. There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO, and the time to lactate normalization. 11 patients died, 7 patients developed bleeding, and 8 cases developed infection. Conclusion Sin- gle-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients. Additionally, creatinine and lactic acid were good indicators for assessing prognosis. Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.