摘要
目的:利用床旁经胸超声心动图对暴发性心肌炎与心肌梗死后行VA-ECMO支持患者的左心收缩功能进行评估,探讨床旁超声心动图在VA-ECMO支持治疗时的应用价值.方法:回顾性分析在我院行VA-ECMO支持的患者32例,选取心源性休克并成功撤机的患者16例,分为暴发性心肌炎(8例)、心肌梗死(8例)两组,对两组内和两组间的一般临床资料以及VA-ECMO支持建立前、建立后24h和成功撤机后的左房内径(LAD)、左室舒张末期内径(LVDD)及射血分数(LVEF)进行对比.结果:(1)一般临床资料比较:较心肌梗死组平均年龄(64.1±6.9岁),暴发性心肌炎组的平均年龄(34.2±9.0岁)更小.(2)组内比较:暴发性心肌炎组LVDD在VA-ECMO支持建立前平均水平(42.9±9.5)mm低于建立后24h平均水平(46.7±8.8)mm;成功撤机后LVEF平均水平(51.5±21.3)%高于建立后24h平均水平(33.9±18.4)%.心肌梗死组在VA-ECMO支持建立前、建立后24h、成功撤机后的LAD、LVDD及LVEF组内比较均无统计学差异.(3)两组间对比:暴发性心肌炎组LAD在VA-ECMO支持建立前、建立后24h和成功撤机后均低于急性心肌梗死组;VA-ECMO支持建立前心肌梗死组LVDD平均水平大于暴发性心肌炎组;成功撤机后暴发性心肌炎组的LVEF高于急性心肌梗死组.结论:VA-ECMO支持可以明显改善暴发性心肌炎组患者的LVEF,暴发性心肌炎对心功能的影响可能可逆;VA-ECMO支持对心肌梗死组LAD、LVDD、LVEF的改善不明显,但可以为其他目的的治疗争取一段时间;暴发性心肌炎组LAD在VA-ECMO支持建立前、建立后24h和成功撤机后转出ICU前均低于急性心肌梗死组;年龄、LAD、LVDD可能影响心功能的恢复.
Objective To evaluate the left ventricular systolic function of patients with fulminant myocarditis and myocardial infarction during veno-arterial extracorporeal membrane oxygenation(VA-ECMO)therapy using bedside transthoracic echocardiography,so as to explore the application value of bedside echocardiography during VA-ECMO therapy.Methods A retrospective analysis was carried out on 32 patients undergoing VA-ECMO support in our hospital.Sixteen patients with cardiogenic shock and successful weaning were selected and divided into two groups:the fulminant myocarditis group(n=8)and the myocardial infarction group(n=8).Further inter-group and intra-group comparisons were performed on the general clinical data,left atrial diameter(LAD),left ventricular end-diastolic diameter(LVDD),and left ventricular ejection fraction(LVEF)before VA-ECMO support,24 hours after VA-ECMO support,and after the successful weaning,respectively.Results(1)Comparison of general clinical data:The average age of the fulminant myocarditis group was smaller than that of the myocardial infarction group[(34.2±9.0)vs.(64.1±6.9)years].(2)Comparison within groups:The average level of LVDD before VA-ECMO support establishment in explosive myocarditis group was lower than that after 24h(46.7±8.8)mm.The average level of LVEF after successful weaning was higher than that 24 hours after VA-ECMO support[(51.5±21.3)%vs.(33.9±18.4)%].Furthermore,in the myocardial infarction group,there were no significant differences in LAD,LVDD and LVEF before VA-ECMO support was established,24h after VA-ECMO support was established,and after successful withdrawal.(3)Comparison between the two groups:The LAD in explosive myocarditis group was lower than that in acute myocardial infarction group before VA-ECMO support was established,24h after VA-ECMO support was established and after successful withdrawal.The average LVDD level of the myocardial infarction group was higher than that of the fulminant myocarditis group before VA-ECMO support.Besides,The LVEF of explosive myocarditis group was higher than that of acute myocardial infarction group.Conclusions VA-ECMO support can significantly improve LVEF in patients with myocarditis and the impact of fulminant myocarditis on cardiac function is possibly reversible.VAECMO support did not significantly improve LAD,LVDD and LVEF in myocardial infarction group,but could buy a period of time for other purposes of treatment.LAD in explosive myocarditis group was lower than that in acute myocardial infarction group before VA-ECMO support was established,24h after VA-ECMO support was established,and before ICU transfer after successful withdrawal.Age,LAD and LVDD may affect the recovery of cardiac function.
作者
杨薇
徐明
王得恩
章向成
YANG Wei;XU Ming;WANG De'en;ZHANG Xiangcheng(Huai'an First Hospital Affiliated to Nanjing Medical University,Ultrasound,Huai'an 223300,China;Huai'an First Hospital Affiliated to Nanjing Medical University,Gerontology,Huai'an 223300,China;Huai'an First Hospital Affiliated to Nanjing Medical University,Critical Care Medicine Department,Huai'an 223300,China)
出处
《湖南师范大学学报（医学版）》
2023年第1期52-56,共5页
Journal of Hunan Normal University(Medical Sciences)
基金
淮安市科技项目(HAP202105)
2020年度省第五期“333工程”科研项目资助计划(BRA2020233)
作者简介
通信作者:王得恩,E-mail:wangdeen11@163.com
