心脏外科术后患者行体外膜肺氧合治疗常见并发症的临床分析

Common complications of extracorporeal membrane oxygenation therapy in patients after cardiac surgery

摘要:

目的 总结体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)治疗心脏外科术后患者的常见并发症及治疗策略。 方法 回顾性分析2016年1月—2022年6月在上海交通大学医学院附属新华医院心胸外科术后因心肺功能不全行体外膜肺氧合治疗的35例患者的术后并发症、治疗措施及预后等临床资料，其中男性24例，女性11例，年龄42~76岁，平均(61.5±11.9)岁。35例患者中，接受瓣膜手术12例，成人先心病5例，大血管手术3例，冠状动脉旁路移植术15例，其中合并瓣膜手术6例。 结果 35名患者均行静脉-动脉ECMO，ECMO辅助时间为116~273 h，平均(187±45) h。20例患者成功撤离ECMO，脱机成功率为57.1%。康复出院15例(42.9%)，无法撤机的患者为15例(42.9%)，5例(14.3%)患者成功脱机后因感染、脑梗死、多器官功能衰竭等原因死亡。29例(82.9%)患者出现ECMO相关并发症，其中肾功能不全(48.5%)为ECMO辅助期间发生率最高的并发症，其次为出血(45.7%)、感染(31.4%)、心律失常(28.6%)等。ECMO辅助时间与治疗是否成功关系密切。 结论 心脏术后重症患者行ECMO治疗伴有较高的并发症发生率及死亡率，在围手术期管理过程中，应积极预防和治疗并发症，尽量缩短ECMO运行时间。

Abstract:

Objective To analyze the common complications of patients treated by extracorporeal membrane oxygenation(ECMO) after cardiac surgery. Methods A retrospective analysis was conducted on the clinical data and perioperative management of 35 patients who underwent extracorporeal membrane oxygenation therapy for cardiopulmonary dysfunction after cardiac surgery at Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to June 2022, including ECMO team building, postoperative complications, treatment measures, multi-system monitoring, and complication management. Of the 35 patients, there were 24 males and 11 females, aged from 42 to 76 years, with an average age of(61.5±11.9) years; 12 underwent valve surgery, 5 had surgery for adult congenital heart disease, 3 underwent major vascular surgery, and 15 underwent coronary artery bypass grafting(CABG), including 6 who also had concurrent valve surgery. Results All 35 patients underwent venous arterial ECMO, the ECMO assisted time was 116-273 hours, with an average time of(187±45) hours. Among them, 20 patients successfully withdrew from ECMO, with a success rate of 57.1%. Fifteen patients(42.9%) were unable to wean off ECMO, and 5 weaned-off patients(14.3%) died of infection, cerebral infarction, multiple organ failure. Fifteen patients(42.9%) recovered and were discharged. Twenty-nine patients(82.9%) experienced ECMO-related complications, with renal dysfunction(48.5%) being the most common complication, followed by bleeding(45.7%), infection(31.4%), and arrhythmia(28.6%). The duration of ECMO support was closely related to the success of the treatment. Conclusion ECMO treatment for critically ill patients following cardiac surgery is associated with a high incidence of complications and mortality. The key to successful treatment lies in actively preventing and treating o the complications during the perioperative management, and striving to minimize the duration of ECMO support.