体外膜氧合联合主动脉球囊反搏在重症心脏病患者中的应用

Application of veno-arterial extracorporeal membrane oxygenation combined with intra-aortic balloon pump in patients with severe heart disease

目的探讨静脉-动脉体外膜氧合(V-AECMO)联合/不联合主动脉球囊反搏(IABP)在重症心脏病患者中的应用及截瘫的发生情况。方法回顾性分析2017年4月至2021年4月厦门大学附属第一医院重症医学科中因心源性休克或心跳骤停应用V-AECMO联合/不联合IABP支持的22例患者的临床资料。鉴定出现截瘫并发症的患者,讨论截瘫的潜在危险因素和病因。结果22例患者平均年龄为(47.8±18.8)岁,13例男性和9例女性。暴发性心肌炎10例,脓毒症心肌病6例,急性心肌梗死6例。22例患者ECMO前序贯器官衰竭评分中位数为11分、左室射血分数平均为(31.8±14.0)%。常见的基础疾病包括动脉硬化6例、高血压3例和冠心病3例。22例患者均进行了有创机械通气和股静脉-股动脉V-AECMO置管及应用肝素抗凝,其中14例患者同时联合了IABP辅助治疗,运行时间为(128.3±89.4)h。22例患者ECMO运行时间中位数为92.5h,中位数住院时间为8d。成功撤机并存活出院的患者比率为31.8%(7/22),暴发性心肌炎患者的存活率为60%(6/10)。22例患者中有2例女性患者出现了截瘫并发症,截瘫发生率为9.1%。结论ECMO在重症心脏病患者的救治中起到了重要的作用,特别是在暴发性心肌炎患者中。在V-AECMO联合IABP支持中出现截瘫的患者发生率比以往国外报道的发生率高,可能还需要更多的大型研究进一步阐明这一并发症的真实发生率。

Objective To investigate the application of veno-arterial extracorporeal membrane oxygenation(V-A ECMO)with/without intra-aortic balloon pump(IABP)in patients with severe heart disease and the incidence of paraplegia.Methods We retrospectively analyzed 22 patients in the Intensive care unit(ICU)of the First Affiliated Hospital of Xiamen University(Xiamen,China)between April 2017 and April 2021,who received V-A ECMO with/without IABP for cardiogenic shock or cardiac arrest.Then,the patients developing paraplegia were identified,and the potential risk factors and etiologies of paraplegia were discussed.Re⁃sults The mean age of the 22 patients was 47.8±18.8 years,including 13 males and 9 females.There were 10 cases of fulminant myo⁃carditis,6 cases of septic cardiomyopathy and 6 cases of acute myocardial infarction.The median pre-ECMO SOFA score was 11 and the mean pre-ECMO left ventricular ejection fraction was(31.8±14.0)%.The common underlying diseases included arteriosclerosis in 6 cases,hypertension in 3 cases and coronary heart disease in 3 cases.All the 22 patients received invasive mechanical ventilation(IMV),femoral V-A ECMO and heparin anticoagulation,among which 14 patients received IABP simultaneously,and the running time was 128.3±89.4 h.The median duration of V-A ECMO support was 92.5 hours and the median length of hospital stay was 8 days.The overall survival rate to discharge was 31.8%(7/22).The survival rate of fulminant myocarditis was 60%(6/10).Two females de⁃veloped paraplegia with an incidence of 9.1%(2/22)in our institution.Conclusion ECMO plays an important role in the treatment of patients with severe heart disease,especially in fulminant myocarditis.In this study,the incidence of paraplegia in patients received V-A ECMO combined with IABP was higher than previously reported abroad.Additional large studies are needed to elucidate the true incidence of this complication.