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目的 总结体外膜式氧合(ECMO)治疗成人患者的经验,分析早期死亡的危险因素.方法 2005年2月至2008年6月,运用ECMO救治45例成人心脏病患者,男性34例,女性11例,平均年龄(49.0±14.1)岁,平均体质量(67.0±12.8)kg.冠状动脉粥样硬化性心脏病21例,瓣膜病8例,心肌病7例.按救治情况分为心脏直视手术后辅助组(A组)31例,心脏移植后辅助组(B组)5例和慢性心力衰竭急性心功能不全组(C组)9例.14例患者此前曾行心肺复苏.采用股动、静脉置管法进行辅助.结果 辅助时间5～648 h,平均(126.7±104.3)h.27例(60.0%)成功脱离ECMO,5例成功辅助至接受心脏移植.院内死亡率42.2%(19/45),9例死于多脏器功能衰竭.26例(57.8%)患者存活出院.A组存活率为58.1%,B组为4/5,C组为4/9.12例患者再次开胸止血,3例患者因置管侧下肢末梢缺血行动脉取栓.11例患者加用主动脉内球囊反搏,6例存活.9例患者辅助期间合并肾功能衰竭而同期血液滤过治疗,仅2例存活.结论 ECMO可有效救治急重症成人心肺功能不全.在重要脏器出现不可逆损害前建立ECMO并预防并发症,是提高救治成功率的关键.

Objective To explore the experience on venoarterial extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac failure. Methods From February 2005 to June 2008, 45 patients (male 34, female 11) undergoing cardiogenic shock required temporary ECMO support. Average age was (49.0±14.1) years. Average body weight was (67.0±12.8) kg. Coronary heart disease occupied in 21 cases, valve disease occupied in 8 cases, and cardiomyopathy occupied in 7 cases. All the patients could be divided into 3 groups: post-cardiotomy (group 1, n=31), post-transplantation (group 2, n=5), decompensate of chronic heart failure (group 3, n=9). Fourteen patients need cardiac resuscitation before ECMO support. ECMO implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta. Results Average support duration of ECMO was (126.7± 104.3) h. Twenty-seven patients could be successfully weaned from support (60.0%), additionally, 5 were bridged to heart transplantation. The in-hospital mortality was 42. 2% (19/45). Twenty-six patients (57.8%) could be successfully discharged. The discharge rate was 58. 1% in group 1,4/5 in group 2 and was 4/9 in group 3. Twelve patients were re-operated for hemostasia. Three patients need femoral arterial thrombectomy because of ischemia of lower extremity. Additional intra-aortic balloon pumps were used in 11 patients, with 6 patients successfully discharged. The mortality rate for patients with acute renal failure treated by continuous renal replacement therapy under ECMO support was obviously high (7/9). The dominant mode of death was multisystem organ failure (9/19). Conclusion Early indication, control of complications, and paying attention to the treatment after ECMO support could improve our results with increasing experience.