中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2010年
11期
696-698
,共3页
邱志兵%肖立琼%陈鑫%石开虎%徐明%蒋英硕%汪黎明%杨婷%张扬波
邱誌兵%肖立瓊%陳鑫%石開虎%徐明%蔣英碩%汪黎明%楊婷%張颺波
구지병%초립경%진흠%석개호%서명%장영석%왕려명%양정%장양파
体外膜肺氧合%终末期心脏病%心力衰竭
體外膜肺氧閤%終末期心髒病%心力衰竭
체외막폐양합%종말기심장병%심력쇠갈
Extracorporeal membrane oxygenation%End-stage cardiopathy%Heart failure
目的 观察体外膜肺氧合(ECMO)对终末期心脏病围手术期心力衰竭患者的治疗效果,总结临床经验.方法 选择本院2007年6月至2010年7月6例终末期心脏病围手术期心力衰竭行ECMO支持治疗的患者,观察ECMO期间患者的血流动力学及转归情况.结果 ECMO支持时间为23～168 h,平均78 h;患者的血流动力学明显改善[平均动脉压(MAP,mm Hg,1 mm Hg=0.133 kPa):78.13±8.01比47.75±5.21,中心静脉压(mm Hg):11.03±3.21比19.36±4.51,心排血量(L/min):4.93±1.01比3.50±0.81,心排血指数(L·min-1·m-2):2.71±0.51比1.91±0.40,肺动脉楔压(mm Hg):12.72±6.52比20.22±6.91,静脉血氧饱和度:0.66±0.13比0.54±0.07],正性肌力药物使用量也显著减少[多巴胺(μg·kg-1·min-1):5.05±0.85比14.20±5.05,肾上腺素(μg·kg-1·min-1):0.05±0.01比0.24±0.04,均P＜0.05].6例患者均顺利脱机.3例康复出院,出院率50%;3例脱机后因多器官功能衰竭(MOF)死亡.主要并发症为出血、弥散性血管内凝血、感染、栓塞.结论 ECMO可对终末期心脏病围手术期严重心力衰竭患者提供有效的支持治疗,但需正确掌握适应证,合理选择患者.
目的 觀察體外膜肺氧閤(ECMO)對終末期心髒病圍手術期心力衰竭患者的治療效果,總結臨床經驗.方法 選擇本院2007年6月至2010年7月6例終末期心髒病圍手術期心力衰竭行ECMO支持治療的患者,觀察ECMO期間患者的血流動力學及轉歸情況.結果 ECMO支持時間為23～168 h,平均78 h;患者的血流動力學明顯改善[平均動脈壓(MAP,mm Hg,1 mm Hg=0.133 kPa):78.13±8.01比47.75±5.21,中心靜脈壓(mm Hg):11.03±3.21比19.36±4.51,心排血量(L/min):4.93±1.01比3.50±0.81,心排血指數(L·min-1·m-2):2.71±0.51比1.91±0.40,肺動脈楔壓(mm Hg):12.72±6.52比20.22±6.91,靜脈血氧飽和度:0.66±0.13比0.54±0.07],正性肌力藥物使用量也顯著減少[多巴胺(μg·kg-1·min-1):5.05±0.85比14.20±5.05,腎上腺素(μg·kg-1·min-1):0.05±0.01比0.24±0.04,均P＜0.05].6例患者均順利脫機.3例康複齣院,齣院率50%;3例脫機後因多器官功能衰竭(MOF)死亡.主要併髮癥為齣血、瀰散性血管內凝血、感染、栓塞.結論 ECMO可對終末期心髒病圍手術期嚴重心力衰竭患者提供有效的支持治療,但需正確掌握適應證,閤理選擇患者.
목적 관찰체외막폐양합(ECMO)대종말기심장병위수술기심력쇠갈환자적치료효과,총결림상경험.방법 선택본원2007년6월지2010년7월6례종말기심장병위수술기심력쇠갈행ECMO지지치료적환자,관찰ECMO기간환자적혈류동역학급전귀정황.결과 ECMO지지시간위23～168 h,평균78 h;환자적혈류동역학명현개선[평균동맥압(MAP,mm Hg,1 mm Hg=0.133 kPa):78.13±8.01비47.75±5.21,중심정맥압(mm Hg):11.03±3.21비19.36±4.51,심배혈량(L/min):4.93±1.01비3.50±0.81,심배혈지수(L·min-1·m-2):2.71±0.51비1.91±0.40,폐동맥설압(mm Hg):12.72±6.52비20.22±6.91,정맥혈양포화도:0.66±0.13비0.54±0.07],정성기력약물사용량야현저감소[다파알(μg·kg-1·min-1):5.05±0.85비14.20±5.05,신상선소(μg·kg-1·min-1):0.05±0.01비0.24±0.04,균P＜0.05].6례환자균순리탈궤.3례강복출원,출원솔50%;3례탈궤후인다기관공능쇠갈(MOF)사망.주요병발증위출혈、미산성혈관내응혈、감염、전새.결론 ECMO가대종말기심장병위수술기엄중심력쇠갈환자제공유효적지지치료,단수정학장악괄응증,합리선택환자.
Objective To summarize the clinical effect and experience of extracorporeal membrane oxygenation (ECMO) support for severe heart failure during peri-operative period of end-stage cardiopathy.Methods From June 2007 to July 2010,6 patients with severe heart failure during peri-operative period of end-stage cardiopathy received ECMO support.The changes in the hemodynamics and outcome of the patients during the use of ECMO were investigated.Results The duration of ECMO assistance ranged from 23 to 168 hours with a mean of 78 hours.The hemodynamics after using ECMO was much improved than before ECMO[mean arterial pressure (mm Hg, 1 mm Hg=0.133 kPa): 78.13±8.01 vs.47.75±5.21,central venous pressure (mm Hg): 11.03±3.21 vs.19.36±4.51, cardiac output (L/min): 4.93±1.01 vs.3.50± 0.81, cardiac index (L · min-1 · m-2): 2.71 ± 0.51 vs.1.91 ± 0.40, pulmonary artery wedge pressure (mm Hg): 12.72 ± 6.52 vs.20.22 ± 6.91, venous oxygen saturation: 0.66 ± 0.13 vs.0.54 ±0.07], and the amount of using inotropic drug was significantly reduced compared with that before ECMO [dopamine(μg · kg-1 · min-1): 5.05 ± 0.85 vs.14.20 ± 5.05, epinephrine (μg · kg-1 · min-1): 0.05 ±0.01 vs.0.24±0.04, all P＜0.05].All patients were successfully weaned from ECMO.After weaning,3 patients recovered and discharged, and the hospital discharge rate was 50%, while 3 patients died of multiple organ failure (MOF).Major complication was bleeding, disseminated inravascular coagulation,infection,embolism.Conclusion ECMO is an important extracorporeal method to support life.ECMO is an effective measure of treatment for end-stage cardiopathy patients with peri-operative severe heart failure.It is important to properly select patients for ECMO.
