主动脉手术后体外膜肺氧合支持的单中心回顾性研究

Extracorporeal membrane oxygenation for post-aortic surgery:A retrospective study in a single center

目的探索阜外医院体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)用于主动脉手术患者的结局并总结经验。方法回顾性分析阜外医院2009—2020年收治的主动脉手术后ECMO辅助患者的临床资料,其中主动脉夹层手术患者为夹层组,非主动脉夹层手术患者为非夹层组,比较两组患者在院生存率及随访生存率并分析死亡原因。结果共纳入22例患者,其中夹层组17例,男13例、女4例,年龄54(46,61)岁;非夹层组5例,男3例、女2例,年龄51(41,65)岁。两组患者年龄和性别差异无统计学意义(P>0.05)。夹层组院内生存率(11.8%vs.100.0%,P=0.001)和随访生存率(11.8%vs.80.0%,P=0.009)明显低于非夹层组患者。夹层组患者院内死亡原因包括大出血和弥散性血管内凝血(3例)、左心室血栓形成(1例)、不可逆脑损伤(2例)、内脏灌注不良综合征(4例)、不可逆心脏功能衰竭(5例)。结论ECMO用于主动脉夹层术后患者死亡率高、管理难度大,与主动脉夹层疾病特点及手术后出凝血障碍有关。对于这类患者更应谨慎把握其适应证,优化管理策略。

Objective To describe the outcomes of extracorporeal membrane oxygenation(ECMO)for patients after aortic surgery and to summarize the experience.Methods The clinical data of patients who received ECMO support after aortic surgery in Fuwai Hospital from 2009 to 2020 were retrospectively analyzed.The patients who received an aortic dissection surgery were allocated into a dissection group,and the other patients were allocated into a nondissection group.The in-hospital and follow-up survival rates were compared between the two groups,and the causes of death were analyzed.Results A total of 22 patients were enrolled,including 17 patients in the dissection group[13 males and 4 females,with a median age of 54(46,61)years]and 5 patients in the non-dissection group[3 males and 2 females,with a median age of 51(41,65)years].There was no statistical difference in the age and gender between the two groups(P>0.05).The in-hospital survival rate(11.8%vs.100.0%,P=0.001)and follow-up survival rate(11.8%vs.80.0%,P=0.009)of the patients in the dissection group were significantly lower than those in the non-dissection group.The causes of death in the dissection group included massive bleeding and disseminated intravascular coagulation(3 patients),ventricular thrombosis(1 patient),irreversible brain injury(2 patients),visceral malperfusion syndrome(4 patients)and irreversible heart failure(5 patients).Conclusion ECMO after aortic dissection surgery is associated with high mortality,which is related to the pathological features of aortic dissection and severely disrupted coagulation system after the surgery.For these patients,strict indication selection and optimal management strategy are important.