体外膜肺氧合在心脏移植术后右心功能衰竭中的应用体会

摘要： 目的 探讨体外膜肺氧合 （ECMO） 在心脏移植术后右心功能衰竭中的应用价值。方法 回顾性分析我院 2016年1月—2018年1月完成的31例心脏移植患者临床资料， 其中3例因术后出现右心功能衰竭应用ECMO辅助治疗。3例患者中男2例， 女1例， 年龄分别为52、 38、 67岁。2例术中植入ECMO辅助治疗， 1例术后8 h行ECMO辅助治疗。ECMO辅助经股动脉、 股静脉植入， 选择V-A模式， 辅助流量在3.0 L/min左右。ECMO治疗期间持续呼吸机支持、 低温镇静、 抗感染、 营养支持治疗。结果 3例患者经ECMO辅助治疗后右心功能均得到改善， 逐步减低辅助流量后脱离ECMO辅助， 均顺利拔除气管插管。1例ECMO辅助后出现肾功能衰竭， 予持续床旁血滤治疗 （CRRT）， 术后20 d后过渡到规律透析， 术后3个月出院后行规律透析治疗； 2例ECMO辅助期间行CRRT治疗， 拔除ECMO后肾功能恢复正常。3例患者呼吸机辅助时间为 （168.6±24.6） h， 重症监护室停留时间为 （31.8±12.5） d， 均无出血及血栓并发症， 术后肺部感染1例， 给予抗感染治疗后好转。3例患者均顺利出院， 复查超声心动图示心功能正常， 2例患者出院后活动自如， 1例透析患者活动轻微受限。结论 ECMO可用于治疗心脏移植术后右心功能衰竭， 可获得满意的临床效果。

Application of extracorporeal membrane oxygenation in right ventricular failure after heart transplantation

Abstract：Objective To summarize the value of extracorporeal membrane oxygenation (ECMO) in right ventricular failure after heart transplantation. Methods Data of 31 cases with orthotopic heart transplantations from January 2016 to January 2018, in Tianjin First Central Hospital were retrospectively analyzed. Three patients received ECMO support because of right ventricular failure after operation. There were two males and one female in these three patients. Their ages were 52, 38 and 67 years old. ECMO was performed in the heart transplantation (2 patients) and eight hours after the surgery. ECMO was established in these patients via femoral artery and femoral vein, V-A model. The mean blood flow was about 3.0 L/min. Continuous ventilator supports, low temperature sedation, anti-infection and nutrition support therapy were applied in the ECMO procedure. Results ECMO was weaned off successfully in all three patients. The time for ECMO was (144-177) h. All three patients were treated with continuous renal replacement therapy (CRRT). One patient had renal failure, the transition was given to regular dialysis after CRRT treatment, and the regular dialysis treatment after discharged from hospital. The ventilator time was (168.6±24.6) h in the three patients. The duration of staying in the intensive care unit was (31.8 ± 12.5) d. All three patients were discharged from the hospital successfully, and their cardiac function was normal. Conclusion ECMO can be used to treat right heart failure after heart transplantation, and the clinical effect is satisfactory.