程序化体外心肺复苏术在心搏骤停患者抢救中的应用

Application of programmed extracorporeal cardiopulmonary resuscitation in rescue of patients with cardiac arrest

目的 探讨程序化体外心肺复苏术(ECPR)用于成人心搏骤停患者抢救的效果.方法 收集2015年1月至2018年8月金华市中心医院院内和院外实施ECPR 25例心搏骤停患者的临床资料,根据预后分为生存组(6例)和死亡组(19例).ECPR步骤根据ECPR流程图进行操作.比较两组性别、年龄、心肺复苏(CPR)时间、体外膜肺氧合(ECMO)辅助时间及上机前血乳酸(Lac)水平的差异.结果 本组25例患者CPR时间为(64.92±25.00)min,ECMO辅助时间为(153.79±70.12)min,上机前Lac水平为(10.30±6.11)mmol/L.12例成功撤除机器辅助,其中6例患者存活出院,存活率为24%,发生院内死亡19例.生存组和死亡组患者性别、年龄、ECMO辅助时间比较差异均无统计学意义(均P>0.05);但生存组CPR时间、上机前Lac水平均明显低于死亡组〔CPR时间(min):25.00±6.16比77.53±11.14,上机前Lac(mmol/L):5.99±6.31比16.77±5.12,均P<0.05〕.结论 ECPR是对传统CPR失败心搏骤停患者抢救的新手段,制定其实施流程图对ECPR进行程序化管理,能缩短传统CPR时间,把握抢救时机,提高心搏骤停患者的抢救成功率.

Objective To summarize the effect of programmed extracorporeal cardiopulmonary resuscitation(ECPR)in rescue of adult patients with cardiac arrest.Methods The clinical treatment data of 25 patients with cardiac arrest who underwent ECPR inside and outside Jinhua Municipal Central Hospital from January 2015 to February 2018 were arranged and divided into survival group(6 cases)and death group(19 cases)according to the prognosis.The specific steps of ECPR were operated according to ECPR flow chart.The differences of gender,age,cardiopulmonary resuscitation(CPR)time,extracorporeal membrane oxygenation(ECMO)assistance time,and blood lactate(Lac)value before operation were compared between the two groups.Results The CPR time of 25 patients in the whole group was(64.92±25.00)min,the ECMO assistant time was(153.79±70.12)min,and the Lac value of blood before operation was(10.30±6.11)mmol/L.Twelve patients were successfully evacuated from the machine.Among them,6 patients survived and discharged,and 19 patients died in hospital.The survival rate was 24%(6/25).There was no significant difference in gender,age and ECMO assistance time between survival group and death group(all P>0.05).However,the CPR time and Lac value in pre-machine blood of survival group were significantly lower than those in death group,and the differences were statistically significant[CPR time(minutes):25.00±6.16 vs.77.53±11.14,Lac value in pre-machine blood(mmol/L):5.99±6.31 vs.16.77±5.12,both P<0.05].Conclusions ECPR is a new method for the rescue of patients with cardiac arrest who have failed in traditional CPR.Formulating the flow chart of its implementation,and carrying out procedural management on ECPR can shorten the traditional CPR time,grasp the timing of rescue,and improve the rescue rate of patients with cardiac arrest.