静动脉体外膜肺氧合在心血管外科围手术期的临床应用

The clinical application of extracorporeal membrane oxygenation in the preoperative period of cardiovascular surgery

目的总结心血管外科围手术期静－动脉体外膜肺氧合（VA-ECMO）临床应用经验，评价其疗效，探讨影响ECMO预后的因素。方法收集2013年8月至2017年7月67例因围手术期心功能衰竭行VA-ECMO辅助治疗的患者临床资料，男41例，女26例；患儿3例，年龄分别为22、24、30个月；成人患者64例，年龄32-78岁，平均（56.52±10.99）岁。结果平均ECMO支持（235.79±123.87）h，平均机械通气（166.11±148.31）h。49例脱离ECMO，其中38例出院，死亡11例（脱离ECMO后28天内）；放弃治疗18例。67例中有42例出现并发症，其中肾功能不全并行连续性肾脏替代治疗14例、术后感染9例、因纵隔渗血二次开胸止血6例、消化道出血4例、插管部位出血3例、肢端末梢缺血3例、下肢静脉血栓形成2例、颅内出血1例。结论VA-ECMO是心血管外科围手术期重症患者的重要治疗手段。把握ECMO指征、早期停止机械通气、集束化治疗（包括预防和控制出血、合理抗凝、控制感染、保护脏器功能、预防肢端末梢缺血）等是提高VA-ECMO救治成功率的关键。

ObjectiveTo summarize and evaluate the clinical effect of extraco-rporeal membrane oxygenation（ECMO） support for critically ill patients after heart surgery, and to explore the factors that influenced the prognosis of ECMO.MethodsThe clinical data of 67 patients undergoing ECMO admitted to the Second Hospital of Jilin University from August 2013 to July 2017 were retrospectively analyzed. The patient＇s age ranged from 22 months to 78 years, including 3 infants aged 22, 24, 30 months and 64 adults ranged from 32 to 78 years, the mean age was（56.52±10.99）years.ResultsThe average ECMO support time was（235.79±123.87）h, the mean mechanical ventilation time was（166.11±148.31）h. 49 patients weaned off successfully from ECMO, 38 of them were discharged and 11 died within 28 days. 18 patients gaved up treatment. 42 patients suffered the complications.ConclusionVA-ECMO is a significant supportive method for preoperative intensive care in patients undergoing cardiovascular surgery. The keys to optimal results are grasping the indications of ECMO, earlier stopping mechanical ventilation, cluster curing（which involves reasonable anticoagulation, protection of organ function, prevention of hemorrhage, infection and limb distal ischemia）.