王丽岚,巫凯敏,欧尾妹,孙广峰,王伟敏,张国明,王斌,王焱

• 1:厦门大学附属心血管病医院急诊科
• 2:厦门大学医学院

摘要(Abstract)：

本文报道了1例31岁急性暴发性心肌炎合并心原性休克的患者，在体外膜肺氧合支持治疗期间经过优化药物、主动脉内球囊反搏联合连续性肾替代治疗仍出现急性肺水肿，再次联合经皮房间隔造口术治疗后肺水肿明显改善。此外，该患者心功能恢复缓慢，延长体外膜肺氧合支持治疗18 d后成功撤机，心功能恢复正常。采用长时程体外膜肺氧合联合经皮房间隔造口术治疗成人暴发性心肌炎罕见，本例报道为临床治疗提供参考。

关键词(KeyWords)： 暴发性心肌炎;肺水肿;体外膜肺氧合;经皮房间隔造口术

Abstract:

Keywords:

基金项目(Foundation): 厦门市联合支持医疗卫生重点项目（3502Z20209006）

作者(Author): 王丽岚,巫凯敏,欧尾妹,孙广峰,王伟敏,张国明,王斌,王焱

参考文献(References)：

• [1] Cooper LT Jr,Keren A,Sliwa K,et al. The global burden of myocarditis:part 1:a systematic literature review for the global burden of diseases, injuries, and risk factors 2010 study[J].Glob Heart,2014,9(1):121-129.
• [2] Li S,Xu S,Li C,et al. A life support-based comprehensive treatment regimen dramatically lowers the in-hospital mortality of patients with fulminant myocarditis:a multiple center study[J].Sci China Life Sci,2019,62(3):369-380.
• [3] Zhang X,Wang S,Jia J,et al. The use of extracorporeal membrane oxygenation in the treatment of fulminant myocarditis:Current progress and clinical outcomes[J]. Microvasc Res,2021,137:104190.
• [4] Tsuboi H,Sone T,Sassa H, et al. Rescue of a patient with fulminant myocarditis by percutaneous extracorporeal bypass[J].Jpn J Med,1990,29(5)519-522.
• [5] Caforio AL,Pankuweit S,Arbustini E,et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis:a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases[J]. Eur Heart J,2013,34(33):2636-2648.
• [6] Lorusso R,Centofanti P,Gelsomino S,et al. Venoarterial extracorporeal membrane oxygenation for acute fulminant myocarditis in adult patients:a 5-year multi-institutional experience[J]. Ann Thorac Surg,2016,101(3):919-926.
• [7]中华医学会心血管病学分会精准医学学组，中华心血管病杂志编辑委员会，成人暴发性心肌炎工作组。成人暴发性心肌炎诊断与治疗中国专家共识[J].内科急危重症杂志，2017,23(6):443-453.
• [8] Chong SZ,Fang CY,Fang HY,et al. Associations with the inhospital survival following extracorporeal membrane oxygenation in adult acute fulminant myocarditis[J]. J Clin Med,2018,7(11):452.
• [9] Posluszny J,Engoren M,Napolitano LM,et al. Predicting survival of adult respiratory failure patients receiving prolonged（≥14 days） extracorporeal membrane oxygenation[J].ASAIO J,2020,66(7):825-833.
• [10] Diddle JW,Almodovar MC,Rajagopal SK,et al.Extracorporeal membrane oxygenation for the support of adults with acute myocarditis[J]. Crit Care Med,2015,43(5):1016-1025.
• [11] Kapur NK,Zisa DC. Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)fails to solve the haemodynamic support equation in cardiogenic shock[J]. EuroIntervention,2016,11(12):1337-1339.
• [12] Maisch B,Ruppert V,Pankuweit S. Management of fulminant myocarditis:a diagnosis in search of its etiology but with therapeutic options[J]. Curr Heart Fail Rep,2014,11(2):166-177.
• [13] Koenig PR,Ralston MA,Kimball TR,et al. Balloon atrial septostomy for left ventricular decompression in patients receiving extracorporeal membrane oxygenation for myocardial failure[J].J Pediatr,1993,122(6):S95-S99.
• [14] Seib PM,Faulkner SC,Erickson CC,et al. Blade and balloon atrial septostomy for left heart decompression in patients with severe ventricular dysfunction on extracorporeal membrane oxygenation[J]. Catheter Cardiovasc Interv,1999,46(2):179-186.
• [15] Prasad A,Ghodsizad A,Brehm C,et al. Refractory pulmonary edema and upper body hypoxemia during veno-arterial extracorporeal membrane oxygenation-a case for atrial septostomy[J]. Artif Organs,2018,42(6):664-669.
• [16] Mlcek M,Meani P,Cotza M,et al. Atrial septostomy for left ventricular unloading during extracorporeal membrane oxygenation for cardiogenic shock:animal model[J]. JACC Cardiovasc Interv,2021,14(24):2698-2707.