摘要目的 探讨体外膜肺氧合(ECMO)支持患者各类并发症发生原因和防治措施.方法 回顾性分析2007年1月至2014年12月上海市胸科医院61例接受ECMO支持患者的并发症发生情况.其中男性43例,女性18例,年龄3～66岁.ECMO病因包括心脏术后低心排血量、病毒性心肌炎、等待肺移植、急性呼吸窘迫综合征、心肌梗死及其他,包括49例静脉-动脉ECMO及12例静脉-静脉ECMO.结果 61例患者辅助时间2～61 d,37例脱机,28例痊愈出院.56例患者发生了并发症,包括氧合器渗漏(4例次)、管路血栓(7例次)、溶血(4例次)、出血(34例次)、感染(8例次)、肾功能损伤(35例次)、下肢缺血(8例次)和神经系统并发症(6例次).存活组中发生各类并发症49例次,死亡组中发生并发症61例次.死亡组发生例次前两位的并发症为肾功能损伤(33例次)和出血(10例次).ECMO技术的进展可影响部分并发症发生率,如直视切开股动脉插管的下肢缺血发生率为6/7,半切开技术的下肢缺血发生率为2/42(4.8％).结论 并发症与ECMO治疗的成败密切相关,积极预防、治疗并发症对提高ECMO支持成功率非常重要.随着经验的积累和技术的进步,部分并发症的发生率显著降低.

abstractsObjective To analyze the reason and treatment of the complications of 61 cases of extracorporeal membrane oxygenation (ECMO) in order to improve survival rate of ECMO treatment.Methods ECMO records from January 2007 to December 2014 in Shanghai Chest Hospital were investigated retrospectively focusing on complications.There were included 43 male and 18 female patients,age 3 to 66 years.Indications for ECMO included post-operative low cardiac output,viral myocarditis,bridge to heart transplantation,acute respiratory distress syndrome and myocardial infarction.There were 49 cases of veno-arterial ECMO and 12 cases of veno-venous ECMO.Results ECMO duration was 2 to 61 days.Among 43 patients,37 patients weaned from ECMO successfully and 28 survived to discharge.Various complications occurred to 56 patients,including oxygenator plasma leakage (4 case times),circuit emboli (7),hemolysis (4),bleeding (34),infection (8),acute kidney injury (35),lower limb ischemia (8) and neurologic complications (6).There were 49 cases times of complications in survivors,while 61 cases times in death group.Bleeding (10 time cases) and acute kidney injury (33 time cases) happened in the death group.Progresses in ECMO technique had influences on complications in some parts.For instance,incidence of lower limb ischemia was 6/7 in cutdown cannulating group,but reduced to 2/42(4.8％) when semi-open technique was applied.Conclusions Complications in ECMO are relative to patients' outcome intimately.Appropriate prevention and treatment of complication play a major role in the success of ECMO support.The incidences of certain complications reduce significantly due to progresses of equipment and medical experiences.