摘要
目的:本研究旨在探讨体外膜肺氧合(ECMO)在成人暴发性心肌炎(FM)合并心原性休克中(CS)的应用价值。方法:纳入2017年3月至2019年9月在湖南省三家医院行ECMO治疗的成人FM合并CS患者,回顾性分析ECMO置入后相关指标变化,患者治疗转归和并发症发生情况。根据使用机械循环辅助方式分为ECMO组和ECMO联合主动脉内球囊反搏(IABP)组(联合辅助组),比较两组患者的基线情况及治疗转归。结果:共有15例患者纳入分析,年龄中位数(四分位数)为29(27,50)岁,女性9例。其中,6例发生心脏骤停,6例联合连续肾脏替代治疗(CRRT)。与治疗前比较,ECMO置入后患者的血N末端B型利钠肽前体水平降低(中位值:8759.0 pg/mL比2964.0 pg/mL,P=0.002),血乳酸水平下降(中位值:5.1 mmol/L比1.7 mmol/L,P=0.008),动脉血酸碱度(pH)提高(7.3±0.2比7.4±0.1,P=0.026),超声心动图测量的左心室射血分数改善[(34.3±10.9)%比(50.0±11.7)%,P=0.004],差异均有统计学意义。其中,ECMO单独辅助组8例,联合辅助组7例,与单独辅助组比较,联合辅助组患者中心脏骤停及联合使用CRRT的比例更高,差异有统计学意义(P均<0.05)。15例接受ECHO辅助治疗的患者中,有6例发生急性肾功能不全接受CRRT治疗,4例发生血管并发症。11例(11/15)患者成功撤除ECMO辅助并存活出院,其ECMO辅助时间为4(3,7)d。其中,ECMO单独辅助组有7例(7/8),联合辅助组有4例(4/7)成功撤机并存活至出院。结论:ECMO辅助能为FM合并CS患者提供有效的循环辅助。ECMO联合IABP辅助循环多被动用于心脏骤停患者救治,主动预防性启动联合治疗可能是提高救治成功率的关键。
Objective:To investigate the clinical implications of extracorporeal membrane oxygenation(ECMO)in adult patients with fulminant myocarditis(FM)and cardiogenic shock(CS).Methods:Patients who received ECMO due to FM complicated by CS between March 2017 and September 2019 from 3 hospitals in Hunan Province were enrolled.The clinical data,outcomes and complications after ECMO implantation were collected and compared to those before ECMO implantation.Patients were divided into ECMO alone and ECMO combined with intra-aortic balloon pump(IABP)(combination group),and baseline data and outcomes were compared between these two subgroups.Results:A total of 15 patients were enrolled with a median(interquartile range)age of 29(27,50)years and 9 were female.Six patients suffered cardiac arrest and 6 patients underwent continuous renal replacement therapy(CRRT).After ECMO implantation,there was a significant decrese in NT-proBNP levels(median value:8759.0 pg/mL vs.2964.0 pg/mL,P=0.002),decrease in blood lactate levels(median value:5.1 mmol/L vs.1.7 mmol/L,P=0.008),increaase in pH(7.3±0.2 vs.7.4±0.1,P=0.026)and increase in left ventricualr ejection fraction detected by echocardiography[(34.3±10.9)%vs.(50.0±11.7)%,P=0.004].Of the 15 patients,8 patients implanted ECMO alone,other 7 patients needed ECMO combined with IABP therapy.Compared with ECMO alone group,patients in combination group were more likely to have cardiac arrest and need CRRT(both P<0.05).As to the complications after ECHO implantation,6 patients suffered from acute renal failure and received CRRT,4 patients suffered from vascular complications.As a whole,11 patients(11/15)successfully weaned from ECMO and survived to discharge,of which,7 patients(7/8)in the ECMO alone group and 4 patients(4/7)in combination group weaned from ECMO and survived to discharge.Conclusions:ECMO was effective in hemodynamic support for patients with FM and CS,and ECMO combined with IABP therapy usually was used in patients wth cardiac arrest.Starting combination therapy as early as possible may be crucial for outcomes of patients with FM and CS.
作者
台适
孙佳星
唐建军
张志辉
潘宏伟
陈雅琴
贺嘉
朱清一
周胜华
Tai Shi;Sun Jiaxin;Tang Jianjun;Zhang Zhihui;Pan Hongwei;Chen Yaqing;He Jia;Zhu Qinyi;Zhou Shenghua(Department of Cardiology,the Second Xiangya Hospital of Central South University,Changsha 410011,China;Department of Cardiology,the Third Xiangya Hospital of Central South University,Changsha 410013,China;Department of Cardiology,Hunan Province Renmin Hospital 410005,Changsha,China)
基金
国家自然科学基金(面上项目,81670269)
国家自然科学基金(青年基金项目,81801394)
关键词
体外膜肺氧合
主动脉内球囊反搏
心原性休克
暴发性心肌炎
机械循环辅助
Extracorporeal membrane oxygenation
Intra‑aortic balloon pump
Cardiogenic shock
Fulminant myocarditis
Mechanical circulatory support
作者简介
通信作者:周胜华,Email:zhoushenghua@csu.edu.cn
