體外心肺復(fù)蘇救治心臟驟?；颊叩牟±盗袌?bào)道

摘要： 目的描述性總結(jié)體外心肺復(fù)蘇(extracorporeal cardiopulmonary resuscitation,ECPR)救治心臟驟?；颊叩念A(yù)后及實(shí)踐經(jīng)驗(yàn)。方法觀察2012年1月至2017年12月陸軍軍醫(yī)大學(xué)第一附屬醫(yī)院體外膜肺氧合(extracorporeal membrane oxygenation,ECMO)團(tuán)隊(duì)救治的全院(胸心外科、急救部、心內(nèi)科、麻醉科、重癥醫(yī)學(xué)科)ECPR患者的臨床資料,對(duì)ECPR組成、團(tuán)隊(duì)配合、患者生存率及并發(fā)癥等進(jìn)行回顧性分析。結(jié)果 13例ECPR患者,年齡16～69歲,中位年齡44歲,其中男性8例。原發(fā)疾病包括急性心肌梗死、暴發(fā)性心肌炎、外科術(shù)后等。均采用股動(dòng)靜脈插管的V-A ECMO模式,從心臟驟停到ECMO建立運(yùn)轉(zhuǎn)時(shí)間26～83 min,中位時(shí)間46 min;ECMO支持時(shí)間為27～189 h,中位時(shí)間為111 h;ECMO撤機(jī)后到出院時(shí)間0～21 d,中位時(shí)間7 d。7例成功撤機(jī),4例存活出院。13例患者中插管部位滲血3例(23. 08%),5例(38. 46%)急性腎功能衰竭,腦死亡1例(7. 69%),2例(15. 38%)肺部感染,1例(7. 69%)心包填塞,插管側(cè)下肢出院輕度跛行1例(7. 69%),多器官功能衰竭3例(23. 08%)。無截肢、肢體缺血壞死并發(fā)癥發(fā)生。結(jié)論熟練有效的ECMO和常規(guī)心肺復(fù)蘇團(tuán)隊(duì)配合,盡量縮短從心臟驟停到ECMO轉(zhuǎn)流的時(shí)間,是保證ECPR救治成功率的重要因素。
Objective To analyze and summarize the practical experience and prognosis of extracorporeal cardiopulmonary resuscitation(ECPR) in the resuscitation of cardiac arrest patients. Methods The clinical data of ECPR patients rescued by our extracorporeal membrane oxygenation(ECMO) team(including departments of cardiothoracic surgery,emergency,cardiology,anesthesiology and intensive care medicine) from January 2012 to December 2017 were collected and retrospectively analyzed. The components of our ECPR team,team cooperation,survival rate and complications were analyzed. Results The 13 ECPR patients were 8 males and 5 females,at an age of 16 ～ 69(median age 44) years. Their primary diseases include acute myocardial infarction,fulminant myocarditis,postoperative surgery,and so on. All the 13 patients underwent V-A ECMO model of femoral arteriovenous intubation. The operation time from cardiac arrest to ECMO establishment was only 26 to 83(median time 46) min,and the time of ECMO support was 27 to 189(median time 111) h. The time from ECMO weaning to discharge was 0 ～ 21(median time 7) d.Seven patients were successfully weaned, and 4 were discharged alive. Incision bleeding occurred in3(23. 08%) patients. Five(38. 46%) patients had acute renal failure,1 patient(7. 69%) brain death,2(15. 38%) patients with pulmonary infection,1(7. 69%) patient with cardiac tamponade,1(7. 69%)patient with slight limp,and 3(23. 08%) patients suffered from multiple organ failure. No complication of amputation or limb ischemia necrosis occurred. Conclusion Skilled and effective teamwork of ECMO and CPR teams,and prompt and rapid initiation of ECPR after cardiac arrest are important factors to ensure the success rate of ECPR treatment.