体外膜肺氧合治疗非心脏外科手术后成人心脏骤停的效果

Resuscitation efficacy of extracorporeal membrane oxygenation in non-postcardiotomy adult patients with cardiac arrest

目的 探讨常规心肺复苏（CCPR）无效的非心脏外科手术后心脏骤停成人应用体外膜肺氧合（ECMO）的疗效.方法 连续人选2010年1月至2015年1月发生非心脏外科手术后心脏骤停并在天津市第三中心医院接受ECMO治疗的成人患者25例,对患者的临床资料进行回顾性分析.患者入选标准：年龄18～75岁;心脏停搏至CCPR时间＜5 min;实施CCPR后10 min内未恢复自主循环,且CCPR时间＜90 min.根据患者是否院内死亡,将患者分为死亡组（18例）和存活组（7例）,比较两组患者的临床特征.存活出院的相关因素分析采用Spearman相关分析.结果 心脏骤停的发病场所中院内占84.0％ （21/25）,病因中急性心肌梗死占80.0％（20/25）.应用ECMO前,实施CCPR的时间为40.0（27.5,72.0）min.应用ECMO的时间为72.0（47.5,128.3）h,9例（36.0％）患者成功撤除ECMO.死亡组的重症监护室住院时间短于存活组[3.0（1.8 ～7.8）d比16.0（11.0～37.0）d,P＜0.01]、24和48 h平均动脉压均低于存活组[分别为（73.2±20.1）mmHg（1 mmHg=0.133 kPa）比（91.1 ± 20.4）mmHg和（63.0±16.7）mmHg比（86.6±18.0） mmHg,P均＜0.05]、72 h血小板计数少于存活组[（57.0 ± 30.1）×109/L比（97.3 ± 31.5）×109/L,P＜0.05].Spearman相关分析显示,应用ECMO后24h平均动脉压（r=0.427,P＜0.05）、48 h平均动脉压（r=0.558,P＜0.05）和72 h血小板计数（r =0.577,P＜0.05）均与存活出院相关.结论 对于CCPR无效的非心脏外科手术后心脏骤停成人,ECMO是一种有效的复苏手段.

Objective To evaluate the resuscitation efficacy of extracorporeal membrane oxygenation （ECMO） for non-postcardiotomy cardiac arrest adult patients post failed conventional cardiopulmonary resuscitation （CCPR）.Methods We retrospectively analyzed the clinical data of a total of 25 consecutive adults who suffered from non-postcardiotomy cardiac arrest and were treated with ECMO post failed CCPR in our hospital between January 2010 and January 2015.Inclusion criteria included：18 to 75 years old;the duration from cardiac arrest to CCPR initiation 〈 5 minutes;no recovery of spontaneous circulation within 10 min after implementation of standard CCPR,and the length of CCPR 〈 90 minutes.Patients were divided into non-survival group （18 cases） and survival group （7 cases） based on their in-hospital outcome and the clinical characteristics were compared.Related factors of survival to discharge were analyzed by Spearman correlation analysis.Results Majority of patients （84.0% （21/25）） developed cardiac arrest in our hospital,mostly due to acute myocardial infarction （80.0% （20/25））.The mean duration of CCPR prior to ECMO support was 40.0 （27.5,72.0） minutes.The mean duration of ECMO support was 72.0 （47.5,128.3） hours and 9 patients （36.0%） were successfully weaned.Intensive care unit stay was significantly shorter （3.0 （1.8-7.8） days vs.16.0 （11.0-37.0） days,P 〈 0.01）,mean blood pressure at 24 and 48 hours after ECMO initiation was significantly lower （（73.2 ± 20.1） mmHg （1 mmHg =0.133 kPa） vs.（91.1 ±20.4）mmHg,P〈0.05;（63.0 ± 16.7）mmHg vs.（86.6 ± 18.0 mmHg）,P 〈0.05,respectively） and platelet count at 72 hours after extracorporeal support was significantly lower （（57.0 ± 30.1） ×109/L vs.（97.3 ± 31.5） × 10^9/L,P 〈 0.05） in the non-survivor group than in survival group.Spearman correlation analysis demonstrated that mean arterial pressure at 24 hours （r =0.427,P 〈0.05） and 48 hours （r =0.558,P 〈 0.05）,and platelet count at 72 hours after extracorporeal support （r =0.577,P 〈 0.05） were significantly correlated with survival to discharge.Conclusion ECMO can be used as an effective alternative for refractory cardiac arrest in non-postcardiotomy adult patients.