CAJ | 학술논문

目的：观察体外膜肺氧合（ ECMO）治疗急性爆发性心肌炎的临床疗效。方法回顾性分析2013年5月至2014年11月南方医科大学顺德第一人民医院重症医学科经ECMO治疗的急性爆发性心肌炎患者临床资料。结果4例患者均表现为难治性心源性休克，3例合并恶性心律失常，2例合并心跳骤停，药物治疗效果不佳。经ECMO（ V－A模式）支持78～183 h后，血流动力学稳定性首先得到改善，然后是心肌损伤标志物（肌钙蛋白I、肌酸肌酶同工酶）明显下降，随后是心脏收缩功能改善，最后是脑利钠肽下降。临床转归：4例均成功撤机，生存出院；出院后恢复良好，在8～17个月的随访中未发现慢性心衰、心脏扩大、严重心律失常，恢复正常生活、学习、工作。并发症方面：2例发生氧合器血浆渗漏，2例置管部位出血，2例股动脉血栓，1例大隐静脉血栓。结论 ECMO是降低爆发性心肌炎患者早期病死率，改善长期预后的有效手段，应尽早启动。另外肌钙蛋白I在评估撤机时机具有潜在价值。
목적：관찰체외막폐양합（ ECMO）치료급성폭발성심기염적림상료효。방법회고성분석2013년5월지2014년11월남방의과대학순덕제일인민의원중증의학과경ECMO치료적급성폭발성심기염환자림상자료。결과4례환자균표현위난치성심원성휴극，3례합병악성심률실상，2례합병심도취정，약물치료효과불가。경ECMO（ V－A모식）지지78～183 h후，혈류동역학은정성수선득도개선，연후시심기손상표지물（기개단백I、기산기매동공매）명현하강，수후시심장수축공능개선，최후시뇌리납태하강。림상전귀：4례균성공철궤，생존출원；출원후회복량호，재8～17개월적수방중미발현만성심쇠、심장확대、엄중심률실상，회복정상생활、학습、공작。병발증방면：2례발생양합기혈장삼루，2례치관부위출혈，2례고동맥혈전，1례대은정맥혈전。결론 ECMO시강저폭발성심기염환자조기병사솔，개선장기예후적유효수단，응진조계동。령외기개단백I재평고철궤시궤구유잠재개치。
Objective To observe the clinical effect of extracorporeal membrane oxygenation ( ECMO) for patients with acute fulminant myocarditis. Methods Patients with acute fulminant myocarditis received ECMO treatment in intensive care unit of the First People's Hospital of Shunde from May 2013 to November 2014 were retrospectively analyzed. Results Refractory cardiogenic shock occurred in 4 patients. Malignant arrhythmia were complicated in 3 patients, cardiac arrest in 2 patients and medical therapy had no effect. After ECMO support for 78 to 183 hours, hemodynamics improved, myocardial damage markers( Creatine Kinase-MB, Cardiac Troponin I) decreased, cardiac systolic function improved and brain natriuretic peptide decreased. Plasma leakage on oxygenator oc?curred in 2 patients, hemorrhage at the catheterization site occurred in 2 patients, femoral arterial thrombosis occurred in 2 patients, thrombosis in great saphenous vein occurred in 1 patient. Four patients weaned ECMO support and survived to hospital discharge. They recovered well to daily lives, studies and work without chronic heart failure, cardiac dilatation ormalignant arrhythmia during the follow-up period of 7 months out to 18 months. Conclusions ECMO is an effective approach which reduces acute phase mortality, improves long-term prognosis in patients with acute fulminant myocarditis and should be used early. CTnIhas thepotential value inthe evaluation ofweaning of ECMO.