Sasaki S, Yasuda K, Matsui Y, Aoi K, Gando S, Kemmotsu O
Division of Intensive Care Unit, Hokkaido University Hospital, Sapporo, Japan.
Jpn J Thorac Cardiovasc Surg. 1999 Jan;47(1):20-6. doi: 10.1007/BF03217935.
Percutaneous cardiopulmonary bypass support is beneficial for patients with circulatory collapse. However, therapeutic strategies of percutaneous cardiopulmonary bypass support for post-cardiotomy LOS have not been determined. We reviewed 9 patients undergoing cardiac surgery and treated with percutaneous cardiopulmonary bypass support to determine an adequate strategy for perioperative use of percutaneous cardiopulmonary bypass support. Patients included 8 males and 1 female with a mean age of 56.4 +/- 3.9 years. Six patients with IHD underwent CABG for 5 and CABG + MVR for 1 patient and 3 patients with valvular disease underwent AVR, AVR + MVR, and Ross operation respectively. Indication for percutaneous cardiopulmonary bypass support was post-cardiotomy LOS in 7 and preoperative cardiogenic shock in 2 patients. All patients underwent IABP associated with percutaneous cardiopulmonary bypass support. Systemic blood pressure was regulated to 100-120 mmHg by percutaneous cardiopulmonary bypass support flow and with minimum inotropic supports.
Six of 9 patients (66.7%) were weaned from percutaneous cardiopulmonary bypass support and 5 patients were discharged. Five of 6 patients (83.3%) with IHD were weaned from percutaneous cardiopulmonary bypass support compared to 1 of 3 patients (33.3%) (p = 0.134) with valvular disease. Hemodynamic conditions in patients weaned from percutaneous cardiopulmonary bypass support were markedly improved within 40 hours of the introduction of percutaneous cardiopulmonary bypass support (mean percutaneous cardiopulmonary bypass support running time: 23.9 +/- 5.5 hrs). In contrast, those unable to be weaned from percutaneous cardiopulmonary bypass support (mean percutaneous cardiopulmonary bypass support running time: 84.3 +/- 6.3 hrs) showed no improvement and developed major complications such as cerebral damage or multiorgan failure.
Perioperative use of percutaneous cardiopulmonary bypass support may be more effective for patients undergoing coronary artery surgery. Limited use of percutaneous cardiopulmonary bypass support within 48 hours may be applicable for post-cardiotomy patients.
体外膜肺氧合（ECMO）对循环衰竭患者有益。然而，ECMO用于心脏术后低心排综合征（LOS）的治疗策略尚未确定。我们回顾了9例接受心脏手术并接受ECMO支持的患者，以确定围手术期使用ECMO支持的合适策略。患者包括8名男性和1名女性，平均年龄为56.4±3.9岁。6例缺血性心脏病（IHD）患者接受冠状动脉旁路移植术（CABG），其中5例行CABG，1例行CABG+二尖瓣置换术（MVR）；3例瓣膜病患者分别接受主动脉瓣置换术（AVR）、AVR+MVR和Ross手术。ECMO支持的指征为7例心脏术后LOS和2例术前心源性休克。所有患者均接受与ECMO支持相关的主动脉内球囊反搏（IABP）。通过ECMO支持流量和最小的血管活性药物支持将系统血压调节至100-120 mmHg。
9例患者中有6例（66.7%）成功撤离ECMO支持，5例患者出院。6例IHD患者中有5例（83.3%）成功撤离ECMO支持，而3例瓣膜病患者中有1例（33.3%）成功撤离（p=0.134）。撤离ECMO支持的患者在开始ECMO支持后40小时内血流动力学状况明显改善（平均ECMO支持运行时间：23.9±5.5小时）。相比之下，那些无法撤离ECMO支持的患者（平均ECMO支持运行时间：84.3±6.3小时）没有改善，并出现了严重并发症，如脑损伤或多器官功能衰竭。
围手术期使用ECMO支持对接受冠状动脉手术的患者可能更有效。在48小时内有限使用ECMO支持可能适用于心脏术后患者。
