2019 年第 8 期 第 14 卷

体外膜肺氧合联合主动脉内球囊反搏对于瓣膜术后心源性休克的救治

Combined use of extracorporeal membrane oxygenation and intra-aortic balloon pump for cardiogenic shock following valvular surgery

作者：吴芳张海波韩杰李岩孟旭

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏外科九病房

英文单位：

关键词：心源性休克；体外膜肺氧合；主动脉内球囊反搏

英文关键词：

• 摘要：

• 【摘要】目的    探讨体外膜肺氧合(ECMO)联合主动脉内球囊反搏(IABP)对瓣膜术后出现心源性休克（CS）患者的效果。方法    选取2011年1月至2018年8月首都医科大学附属北京安贞医院因瓣膜术后出现CS行ECMO辅助患者31例，根据是否应用IABP辅助分为单纯ECMO组（18例）和ECMO联合IABP组（13例）。比较2组手术相关资料、并发症发生率、术前及ECMO辅助48 h后生化相关指标和进入重症监护病房时、上机时、上机24 h后、上机48 h后的临床相关指标。结果    2组脱机率和院内生存率比较，差异均无统计学意义（均P＞0.05）。ECMO联合IABP组气管插管时间、术后24 h引流量明显长于/大于单纯ECMO组［（282±244）h比（140±109）h、（867±446）ml比（372±200）ml］，术后脑出血发生率明显高于单纯ECMO组（均P＜0.05）。ECMO辅助48 h后，ECMO联合IABP组天冬氨酸转氨酶、丙氨酸转氨酶水平均明显高于单纯ECMO组（均P＜0.05）。ECMO联合IABP组上机24 h后碳酸氢根离子水平和上机48 h后pH值、碳酸氢根离子水平均低于单纯ECMO组，上机24 h后血氧饱和度、血乳酸水平和上机48 h后血乳酸水平均高于单纯ECMO组，差异均有统计学意义（均P＜0.05）。结论    对于瓣膜术后出现CS患者，在ECMO辅助基础上联合应用IABP，并不能提高患者脱机率及院内生存率，同时会增加脑出血及代谢性酸中毒发生率。

• 【Abstract】Objective    To investigate the effect of extracorporeal membrane oxygenation(ECMO) combined with intra-aortic balloon pump(IABP) on patients with cardiogenic shock(CS) after valve surgery. Methods    From January 2011 to August 2018, 31 patients with CS after valve surgery undergoing ECMO were enrolled at Beijing Anzhen Hospital, Capital Medical University. According to the therapeutic regimen, they were divided into ECMO group(18 cases) and ECMO+IABP group(13 cases). Operation records, complications, biochemical indexes before operation and 48 h after using ECMO, clinical indicators at entry to intensive care unit, at the beginning of ECMO, 24 h and 48 h after using ECMO were analyzed. Results    There was no significant difference of weaning rate and in-hospital survival rate between groups(P＞0.05). Endotracheal intubation time and postoperative 24 h drainage volume in ECMO+IABP group were significantly longer/more than those in ECMO group［（282±244）h vs （140±109）h, （867±446）ml vs （372±200）ml］; incidence of postoperative cerebral hemorrhage in ECMO+IABP group was significantly higher than that in ECMO group（all P＜0.05）. At 48 h after using ECMO, serum levels of aspartate aminotransferase and alanine aminotransferase in ECMO+IABP group were significantly higher than those in ECMO group(all P＜0.05). Level of bicarbonate ions at 24 h, 48 h and pH value at 48 h after using ECMO in ECMO+IABP group were significantly lower than those in ECMO group; blood oxygen saturation at 24 h and blood lactic acid content at 24 h, 48 h after using ECMO in ECMO+IABP group were significantly higher than those in ECMO group（all P＜0.05）. Conclusion    Combined use of ECMO with IABP may increase cerebral bleeding and metabolic acidosis risk and shows no benefit on weaning rate and in-hospital survival.