卢安东,潘晨亮,雷鹏,蔡玮婷,赵存瑞,王俊乾,王淑萍,张丽霞,张博,白明,张钲

• 1:兰州大学第一医院心脏中心

摘要(Abstract)：

目的总结体外膜肺氧合(ECMO)在心血管急危重症临床应用的经验,评价其疗效。方法纳入2019年3月至2019年9月兰州大学第一医院收治并行ECMO辅助治疗的患者24例。其中,经皮冠状动脉介入治疗(PCI)组12例均在手术室建立ECMO,心原性休克组12例均在冠心病重症监护室(CCU)建立ECMO。回顾性分析24例患者的临床资料。结果 PCI组12例均在导管室手术完成后顺利撤离ECMO(脱机率12/12),12例均存活出院(生存率12/12);ECMO辅助时间1.3～4(2.6±1.5)h,辅助流量1.7～2.8(2.1±0.4)L/min;2例联合应用主动脉内球囊反搏(IABP)治疗。PCI组完全再血管化达11例(11/12),1例因右冠状动脉慢性完全闭塞反复尝试后未开通。PCI组患者术后第7天左心室射血分数(LVEF)较术前差异无统计学意义(P>0.05)。心原性休克组12例患者中10例顺利脱离ECMO(脱机率10/12),8例存活出院(存活率8/12),2例成功撤除ECMO后死亡(下消化道出血1例,无法脱离IABP 1例);ECMO辅助时间73～223(139.2±46.6)h;术后第7天LVEF较术前明显增加(P<0.05)。24例患者均无机械故障及氧合器故障,无脱管,无下肢缺血坏死,无心脏压塞;共发生出血并发症11例。结论 ECMO是急危重症冠心病行PCI的重要的保驾护航手段之一,可以使得心原性休克患者获益,提高心原性休克生存率。高效的ECMO团队、ECMO时机的把握、精细化个体化管理、有效控制和预防并发症是ECMO救治成功的关键因素。

关键词(KeyWords)： 体外膜肺氧合;心血管急危重症;经皮冠状动脉介入治疗;心原性休克;并发症

Abstract:

Keywords:

基金项目(Foundation): 甘肃省自然科学基金(17JR5RA268)

作者(Author): 卢安东,潘晨亮,雷鹏,蔡玮婷,赵存瑞,王俊乾,王淑萍,张丽霞,张博,白明,张钲

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