摘要目的 回顾性分析100例心肺功能衰竭患者应用体外膜式氧合(ECMO)支持治疗的临床经验.方法 2004年12月至2008年9月,对100例心肺功能衰竭患者行ECMO支持治疗.其中男性67例,女性33例;年龄5 d～76岁,平均(28±26)岁;体质量3.8～100.0 kg,平均(42±30)kg.采用全肝素涂抹技术的氧合器和离心泵ECMO系统,婴幼儿采用右心房-升主动脉插管,成人应用右心房-股动脉插管或股-动静脉插管,辅助期间流量40～220 ml·kg-1·min-1.结果 辅助时间12～504 h,平均(119±80)h.61例(61.0%)顺利撤离ECMO装置,ECMO平均时间(108±59)h;其中康复出院55例(90.2%),6例患者撤机后院内死亡.39例患者不能脱机或放弃治疗,ECMO平均时间(136±102)h.总出院率55.0%.存活患者ECMO前平均动脉压高于死亡患者(P=0.038);死亡患者ECMO前血乳酸水平高于存活患者(P=0.005).结论 ECMO支持是一种有效的循环呼吸衰竭辅助支持治疗方法,尽早对心肺衰竭患者使用ECMO支持治疗,避免重要脏器不可逆损伤,对提高治疗效果有积极的帮助.

abstractsObjective To describe the experience with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support of 100 patients.Methods Retrospective analysis of the medical files of 100 patients submitted to the implant of extracorporeal membrane oxygenation system for cardiorespiratory assistance of acute and refractory cardiogenic shock from December 2004 to September 2008.There were 67 males and 33 females,age ranged from 5 d to 76 years with a mean of (28±26) years,body mass ranged from 3.8 to 100.0 kg with a mean of (42±30) kg.The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique.All patients were applied veno-artery ECMO and activated ECMO time was 12 to 504 h with a mean of (119±80) h.Sixty-one patients (61.0%) weaned off successfully from ECMO,55 of them (90.2%) were discharged and 6 died of post-operative complications.Thirty-nine patients could not weaned off from ECMO.Total survival discharge rate was 55.0%.Mean aortic pressure before ECMO in survived patients was significantly higher than that of dead patients (P=0.038).Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients (P=0.005).Conclusions ECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure after cardiac surgery.Earlier usage of ECMO for heart lung failure patient and avoiding the main organs from un-recovery trauma are key success.