体外人工膜肺氧合在暴发性心肌炎中的应用

Application of Extracorporeal Membrane Pulmonary Oxygenation in Fulminant Myocarditis

目的探讨体外人工膜肺氧合(extracorporeal artificial membrane pulmonary oxygenation,ECMO)在暴发性心肌炎中的应用价值。方法选取2018年1月—2020年3月本院收治的15例暴发性心肌炎患者作为研究对象,对所有患者应用ECMO系统进行治疗,观察ECMO应用前后超声心动图指标[左室收缩末期内径(left ventricular end systolic diameter,LVESD)、左室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、左室射血分数(left ventricular ejection fraction,LVEF)]、血流动力学指标[心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean artery pressure,MAP)]的变化,并观察患者转归和并发症发生情况。结果和ECMO应用前相比,ECMO应用后15例患者LVESD、LVEDD均逐渐增加,直至应用96 h时逐渐降低,而15例患者LVEF逐渐下降,直至应用72 h时逐渐上升,但差异均无统计学意义(P> 0.05);和ECMO应用前相比,ECMO应用24 h后,15例患者SBP、DBP及MAP均明显上升,但与应用96 h相比,在撤机前2 h均明显降低,差异有统计学意义(P<0.05);15例患者HR在ECMO应用前后变化差异无统计学意义(P> 0.05);15例患者脱机成功率为86.67%,存活出院率为80.00%;15例患者中有3例发生感染、2例发生下肢血栓、7例发生肾功能损伤。结论 ECMO是临床治疗暴发性心肌炎的有效方法,值得推介。

Objective To explore the application value of extracorporeal artificial membrane pulmonary oxygenation(ECMO)in fulminant myocarditis.Methods Fifteen patients with fulminant myocarditis admitted to our hospital from January 2018 to March 2020 were selected as the research objects.All patients were treated with ECMO system.The changes of echocardiogram indexes[left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)],hemodynamic indexes[heart rate(HR),systolic pressure(SBP),diastolic pressure(DBP),mean arterial pressure(MAP)]before and after ECMO application were observed,and the prognosis and complications of the patients were observed.Results Compared with before ECMO application,LVESD and LVEDD of 15 patients increased gradually after ECMO application until 96 h,while LVEF of 15 patients decreased gradually until 72 h,but the differences were not statistically significant(P>0.05).Compared with before ECMO application,SBP,DBP and MAP of 15 patients were significantly increased after 24 hours of ECMO application,but compared with 96 hours,they were significantly reduced 2 hours before weaning,and the differences were statistically significant(P<0.05).There was no significant difference in HR between 15 patients before and after ECMO application(P>0.05).The success rate of weaning 15 patients was 86.67%,and the survival and discharge rate was 80.00%.Among the 15 patients,3 had infection,4 had hemolysis and 7 had renal function injury.Conclusion ECMO is an effective method for clinical treatment of fulminant myocarditis and is worth recommending.