论文部分内容阅读
目的通过体外膜肺氧合(ECMO)治疗与传统常规治疗比较,系统观察ECMO应用于支持治疗重度心力衰竭的临床效果与安全性,为临床治疗重度心力衰竭提供一种新的治疗手段。方法选择阜外医院2011年1月至2013年12月诊断为心力衰竭患者100例,其中男性71例,女性29例;年龄18~75岁,平均年龄53岁;体质量(66.6±12.7)kg。采取1∶1病例对照研究方法分成ECMO治疗组(50例)和常规治疗组(50例)。常规治疗组采用常规治疗,即强心、利尿、扩血管等药物治疗。ECMO治疗组在常规治疗基础上采用ECMO治疗。记录两组患者人口学特征、入院后最差血气分析和动脉血压、出院时血气和动脉血压、住院期间并发症、出院生存率等指标。然后采用统计学软件分析进行比较。结果两组患者临床资料差异无统计学意义(P>0.05)。两组患者入院后血压、血气和pH值比较,ECMO治疗组低于常规治疗组,差异有统计学意义(P<0.05);血乳酸及PaO_2,ECMO治疗组高于常规治疗组。两组患者出院前血压和血气比较结果显示,ECMO治疗组舒张压均低于常规治疗组(6.92 kPa±0.27 kPa vs 7.85 kPa±0.27 kPa),差异有统计学意义(P<0.05);血pH值、PaO_2、HCO_3~-和SaO_2,ECMO治疗组高于常规治疗组(7.41 vs 7.33,20.22 kPa±1.60 kPa vs 14.76 kPa±2.00 kPa,23.8 mmol/L±0.5 mmol/L vs 20.5 mmol/L±1.5 mmol/L,12.92 kPa±0.55 kPa vs 12.24 kPa±1.16 kPa),差异有统计学意义(P<0.05)。出血并发症发生率ECMO治疗组明显高于常规治疗组。两组住院期间心肺复苏,常规治疗组明显低于ECMO组。两组患者平均住院天数差异无统计学意义。出院存活率ECMO治疗组为44%,常规治疗组为24%,存活率明显高于后者。结论 ECMO支持治疗是治疗重度心力衰竭的有效手段,对于常规治疗疗效不佳的重度心力衰竭,ECMO具有较好的临床效果及常规治疗无法替代的地位。合适的ECMO建立时机,完善的ECMO操作流程是ECMO成功的关键。
Objective To observe the clinical effect and safety of ECMO in supporting and treating severe heart failure by ECMO compared with conventional treatment, and to provide a new therapeutic approach for clinical treatment of severe heart failure. Methods Fu Wai Hospital from January 2011 to December 2013 were diagnosed with heart failure in 100 patients, 71 males and 29 females; aged 18 to 75 years, mean age 53 years; body weight (66.6 ± 12.7) kg . A 1: 1 case-control study was divided into ECMO treatment group (50 cases) and conventional treatment group (50 cases). Conventional treatment group using conventional treatment, namely cardiac, diuretic, vasodilator and other drug treatment. ECMO treatment group on the basis of conventional treatment with ECMO treatment. The demographic characteristics, worst blood gas analysis and arterial blood pressure after admission, blood gas and arterial blood pressure at hospital discharge, complication during hospitalization and discharge rate were recorded. Then use statistical software analysis for comparison. Results There was no significant difference in clinical data between the two groups (P> 0.05). The blood pressure, blood gas and pH value of two groups of patients after admission were lower than those in the conventional treatment group (P <0.05). The levels of blood lactic acid, PaO2 and ECMO in the ECMO treatment group were higher than those in the conventional treatment group. The results of blood pressure and blood gas before discharge from the two groups showed that the diastolic blood pressure in the ECMO treatment group was lower than that in the conventional treatment group (6.92 kPa ± 0.27 kPa vs 7.85 kPa ± 0.27 kPa), with significant difference (P <0.05) (7.41 vs 7.33, 20.22 kPa ± 1.60 kPa vs 14.76 kPa ± 2.00 kPa, 23.8 mmol / L ± 0.5 mmol / L vs 20.5 mmol / L ± Pa), PaO 2, HCO 3 -3 and SaO 2 in the ECMO treatment group 1.5 mmol / L, 12.92 kPa ± 0.55 kPa vs 12.24 kPa ± 1.16 kPa), the difference was statistically significant (P <0.05). The incidence of bleeding complication was significantly higher in the ECMO-treated group than in the conventional treatment group. Cardiopulmonary resuscitation during hospitalization between the two groups was significantly lower in the conventional treatment group than in the ECMO group. There was no significant difference in average length of stay between the two groups. Survival rate was 44% in the ECMO treatment group and 24% in the conventional treatment group, with a significantly higher survival rate than the latter. Conclusion ECMO supportive therapy is an effective treatment for severe heart failure. ECMO has a good clinical effect and irreplaceable status for routine treatment of severe heart failure. The right time to build ECMOs and a sound ECMO operational process are the keys to ECMO’s success.