摘要目的 总结16例使用体外膜肺(ECMO)装置代替体外循环并术后为体外膜肺辅助的临床经验,探讨体外膜肺临床应用的新方法.方法 利用体外膜肺建立体外循环施行心脏直视手术,术后利用同一套装置为体外膜肺辅助.全组患者均使用美顿力体外膜肺机,CB4649离心泵;15例应用541T膜肺,1例应用CARMEDA涂层膜肺.术前均采用股动、静脉切开置管、A-V转流方式.结果 术中及术后转为体外膜肺过程顺利,无并发症发生.本组患者体外膜肺脱机率93.75%,病死率18.75%,出院率81.25%.结论 体外膜肺是治疗重症心、肺衰竭的有效手段.对于预计术后需心肺辅助的患者,术中使用体外膜肺装置建立体外循环,术后转为体外膜肺支持,能够提供术中、术后无间断的心肺辅助,降低炎性反应及血液成分破坏,降低治疗费用.

abstractsObjective To summarize the clinical experiences in setting up cardiopulmonary bypass(CPB)using extracorporeal membrane oxygenation(ECMO)circuit and turning CPB to ECMO after open heart operations in 16 cases.Methods In the group of 16 cases,the annulations were via femoral vessels:by Medtronic ECMO machine and membrane oxygenator was used in all patients.All patients accepted A-V bypass.Results CPB was running smoothly during the operations,and converted to ECMO after the surgeries without complications,and the rate of ECMO withdraw was 93.75%.Mortality was 18.5%,and 81.25%of patients were discharged.Conclusion ECMO is an effective device for cardio and pulmonary support.Many patients with severe cardiac diseases and marginal cardiac function will need mechanical support after surgery.For these patients,setting up CPB using ECMO circuit during the operation and converting it to ECMO after surgery can prevent patients from additional exposure to a standard CPB circuitry.It helps decrease the inflammatory response,avoid dilution of patient's volume of cells and factors,and reduce expenses.