Smedira N G, Blackstone E H
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio, USA.
Ann Thorac Surg. 2001 Mar;71(3 Suppl):S60-6; discussion S82-5. doi: 10.1016/s0003-4975(00)02626-6.
The need for postcardiotomy mechanical support is uncommon, with an incidence of 0.5%.
Multivariable logistic regression analysis of factors associated with postcardiotomy extracorporeal membrane oxygenation (ECMO) support was investigated in 19,985 patients, of whom, 97 required ECMO.
Younger age, number of reoperations, emergency operation, higher creatinine, greater left ventricular dysfunction, and history of myocardial infarction were significant predictors. Overall survival was 35%, but significantly better (72%) in the subgroup converted to an implantable system and then bridged to transplantation.
Patients at increased risk for mechanical support can be identified preoperatively and patient management modified as indicated. Improvement in postcardiotomy survival has been realized by bridging to transplantation. In nontransplant candidates, permanent support may be the only option for increasing survival.
心脏手术后机械支持的需求并不常见，发生率为0.5%。
对19985例患者进行多变量逻辑回归分析，研究与心脏手术后体外膜肺氧合（ECMO）支持相关的因素，其中97例需要ECMO。
年龄较小、再次手术次数、急诊手术、肌酐水平较高、左心室功能障碍较重以及心肌梗死病史是显著的预测因素。总体生存率为35%，但在转换为可植入系统然后过渡到移植的亚组中显著更高（72%）。
术前可识别出机械支持风险增加的患者，并根据情况调整患者管理。通过过渡到移植已实现心脏手术后生存率的提高。在不适合移植的患者中，永久支持可能是提高生存率的唯一选择。
