体外膜氧合在暴发性心肌炎救治中的应用

The application of extracorporeal membrane oxygenation in patients with fulminant myocarditis

目的总结体外膜氧合(ECMO)技术在暴发性心肌炎(FM)救治中的应用效果。方法回顾性分析2015年8月至2019年12月本中心收治的10例接受ECMO辅助的FM患者临床资料,对比辅助前后脑利钠肽前体(NT-proBNP)、血乳酸及肝肾功能等指标的变化,观察并发症发生情况及临床转归。结果10例患者均为女性;成人9例,儿童1例,年龄(28.8±13.1)岁;均行静脉-动脉模式的ECMO治疗;ECMO辅助24 h后,NT-proBNP由辅助前的(24626.1±9442.2)ng/L降至(10141.7±9789.4)ng/L(P=0.014),血乳酸由辅助前的(10.8±5.6)mmol/L降至(3.1±1.7)mmol/L(P=0.007);ECMO治疗中位时间5.8(2.8~28.2)d;8例撤机成功,1例撤机失败,1例接受心脏移植;2例因脑出血死亡;1例辅助前昏迷患者持续未醒转院治疗;共7例患者存活出院。结论ECMO作为短期机械循环支持工具,可以提供有效的循环支持,纠正FM患者循环功能障碍,为心功能恢复或心脏移植提供机会。

Objective To summarize the application experience and effect of extracorporeal membrane oxygenation(ECMO)in patients with fulminant myocarditis(FM).Methods From August 2015 to December 2019,the clinical data of 10 patients with FM who treated with ECMO at the First Medical Center of PLA General Hospital were retrospectively analyzed.The changes of N-terminal pro b-type natriuretic peptide(NT-proBNP),blood lactic acid(LAC)value,liver and kidney function and other indexes before and after the ECMO assistance were compared,and the incidence of complications and the clinical outcomes were observed.Results All the 10 patients(female,9 adults and 1 child,age 28.8±13.1 years)were treated with V-A ECMO.After 24 hours of ECMO support,the mean NT-proBNP decreased significantly from 24626.1±9442.2 ng/L to 10141.7±9789.4 ng/L(P=0.014),and the mean LAC decreased significantly from 10.8±5.6mmol/L to 3.1±1.7mmol/L(P=0.007).The median ECMO duration was 5.8 days(2.8-28.2 days);8 patients were successfully weaned from ECMO,1 failed,and 1 received heart transplantation;2 patients died of cerebral hemorrhage and 1 patient who was in coma before ECMO was transferred to local hospital due to sustained coma;a total of 7 patients survived to discharge.Conclusion As a short-term mechanical circulatory support,ECMO can be effectively used in patients with FM to provide circulatory support,as a bridge to cardiac recovery or heart transplantation.