摘要
目的急性暴发性心肌炎患者在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持下,容易出现左室扩张.本研究实施目标导向性左室保护策略,并探讨其对左室功能及预后的影响.方法因伦理限制,以2013年5月至2016年4月在我院行ECMO治疗的心肌炎患者作为历史对照组,选择2016年5月至2019年5月在我院经ECMO治疗的暴发性心肌炎患者作为研究对象,纳入左室保护组.左室保护策略是充分发挥重症超声早期诊断左室扩张的作用,以膜肺前静脉血氧饱和度作为导向调整ECMO流量,滴定容量及血压目标,使用小剂量正性肌力药物干预长时间心肌顿抑,必要时联用主动脉内球囊反搏实现左心减压.比较两组基线资料、血流动力学变化、心肌顿抑时间、左室扩张及生存出院等情况.结果历史对照组7例,左室保护组9例.两组在ECMO支持前基线资料及ECMO支持24h时血流动力学参数比较差异无统计学意义.ECMO支持48 h时,左室保护组与历史对照组比较中心静脉压降低(mm Hg:10.3±2.7vs.14.0±3.6,t=2.334,P=0.035),左室射血分数增加(37.7±7.0 vs.27.6±8.5,t=-2.608,P=0.021).两组ECMO支持时间、机械通气时间、ICU住院时间比较差异无统计学意义.与历史对照组比较,左室保护组心肌顿抑时间缩短(h:27.5±22.4vs.6.1±8.0,t=2.523,P=0.027).历史对照组有3例发生左室扩张,左室保护组1例左室扩张.历史对照组、左室保护组ECMO撤机成功例数分别为7例、8例,生存出院例数分别为5例、8例.结论ECMO治疗急性暴发性心肌炎患者期间,实施目标导向性左室保护策略可能有助于左室功能恢复.
Objective Left ventricular distension commonly occurred in the acute fulminant myocarditis patients during extracorporeal membrane oxygenation(ECMO)support.The aim of this study was to determine the efct of left ventricular protection stratgies in acute fulminant myocarditis patients supported with ECMO.Methods To adopt history case-control study,the patients were divided into history control group(from May 2013 to April 2016)and left ventricular protection group(from May 2016 to May 2019).The strategy of left ventricular protection was to give full play to the role.of early diagnosis of left ventricular dilatation by critical ulrasound,adjusted the ECM0 flow by taking the venous oxygen saturation of the pre-membrane,titration volume and blood pressure target,used low-dose positive inotropie drugs to intervene long-term myocardial stunning,and used intra-aortie balloon pump(IABP)for left ventricular decompression if necessary.Baseline characteristics including hemodynamics,the time of myocardial stunning,left ventricular distension and the survival of hospital dischange were compared between two groups.Results Seven patients were in history control group and nine patients were in left ventricular protection group.There were mo significant difference in baseline characteristics before ECMO support and hemodynamie indexes at 24 hour after ECMO support between the groups.Al 48 hour after ECMO support,left ventricular protection group has lower central venous pressure[CVP,(10.3±2.7)mm Hg vs.(14.0±3.6)mm Hg,t=2.334,P=0.035],higher ejection fraction(37.7±7.0 vs.27.6±8.5,t=-2.608,P=0.021)compared with history control group.No signifieant differences were observed in the duration of ECMO support,the day of mechanical ventilation and length of ICU stay between two groups.Compared with the history control group,the length of myocardial stunning was shorter in the left ventricular protection group[(6.1±8.0)h vs.(27.5±22.4)h,t=2.523,P=0.027].There were four patients with left ventricular distension,3 patients in history control group,and 1 patient in the left ventricular protection group.In history control group and left ventricular protection group,the number of sccessful weaning was 7 and B respectively,and the number of the discharged cases was 5 and 8 respectively.Conclusion The goal-directed left ventricular protection strategies could improve left ventricular function in acute fulminant myocarditis patients during ECMO support.
作者
周柱江
刘长智
卢剑海
朱瑞秋
左六二
Zhou Zhu-jiang;Liu Chang-zhi;Lu Jian-hai;Zhu Rui-qiu;Zuo Liu-er(Department of Critical Care Medicine,Shunde Hospital,Southern Medical Unirersity,Foashan 528300,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2020年第7期595-600,共6页
Chinese Journal of Critical Care Medicine
基金
广东省医学科研基金项目(A2019237)。
关键词
体外膜肺氧合(ECMO)
急性暴发性心肌炎
左室扩张
Extracorporeal membrane oxygenation(ECMO)
Acute fulminant myocarditis
Left ventricular distension
