中国体外生命支持临床汇总报告

摘要

目的 回顾性分析中国体外膜肺氧合(ECMO)治疗的临床结果和经验,对比体外生命支持组织(ELSO)公布的全球ECMO信息,寻找我国ECMO治疗差距,促使其在我国的进一步推广.方法 2002年1月至2010年5月我国六家医疗中心共实施339例临床ECMO治疗,年龄17天～89岁,其中新生儿4例,65岁以上的老年患者55例.汇总分析不同类型ECMO的临床结果,对比不同年龄阶段患者ECMO辅助的脱机率、出院率及并发症发生情况.结果 ECMO最短辅助时间11 h,最长辅助553 h.用于单纯呼吸支持65例,心脏支持248例,体外心肺复苏(ECPR)26例.总体脱机率63%,成功出院率26%.不同年龄阶段ECMO辅助期间的并发症发生呈现不同的态势,最多见的并发症为手术切口及插管部位出血、感染、急性肾功能不全、高血糖,氧合器故障等在ECMO期间均属高发,弥漫性血管内凝血(DIC)及多脏器衰竭(MOF)是被迫终止ECMO的主要原因.结论 我国ECMO起步较晚,总体水平仍然较低,在我国ECMO用于心脏支持多于呼吸支持.合适的ECMO建立时机,完善的ECMO建立流程,积极防治并发症是ECMO成功的关键;多学科、多部门间的密切团队合作是ECMO成功的保障.%OBJECTIVE Retrospectively analyzed the clinic outcomes and experiences of extracorporeal membrane oxygenation ( ECMO ) in China, which was compared with international summary of extracorporeal life support reported by extracorporeal life support organization ( ELSO ) in 2010. in order to find out the problems of ECMO treatment and to improve the development of ECMO technique in China. METHODS There were 339 patients, aged from 17 days to 89 years, treated by ECMO from January 2002 to May 2010 at 6 famous medical centers in our country. There were 4 neonates and 55 patients over 65 years. We summarized and analyzed the clinical results of different type of ECMO, then compared the survive rate from ECMO. discharged rate and complications rate of different age group patients in the summary of extracorporeal life support by ELSO in China. RESULTS Longest ECMO support was 553 hrs while shortest one was 11 hrs. 65 patients initiated ECMO for respiratory failure, 248 patients with heart dysfunction were performed ECMO and 26 were resuscitated by ECMO in emergency situation. In our summary , general rate of survived from ECMO was 63％ and discharged rate from hospital just was 26％. Complications of ECMO were different based on the different age group of patients. The most common complication was bleeding of operative site in ECMO patients. Infections. acute renal dysfunction, hyperglucia and oxygenator failure were also frequently happened during ECMO. Disseminated intravascular coagulation ( DIC ) and multiple organs failure ( MOF ) were main reasons of yielding up ECMO support. CONCLUSION ECMO started slowly in our country and general clinic outcomes still not very impressive. Cases of ECMO cardiac support was more than that of ECMO respiratory support in China. It is the most important items that perfect protocol and proper initiation of ECMO system and prevention and therapy of complications. ECMO success could be protected by close cooperation of team work among multi departments and hospitals.