静脉-动脉体外膜肺氧合在心源性休克患者中的应用价值

The usefulness of Veno-Arterial Extracorporeal Membranous Oxygenation in Patients with Cardiogenic Shock.

作者信息

Abouelwafa Mohamed, Radwan Waheed, Abdelfattah Alia, Abdelbary Akram, Khaled Mohamed, Samy Wael, Yousry Mohamed, Saeed Ahmed, Saad Mahmood

机构信息

Critical Care Department, Cairo University Hospitals, Cairo, Egypt.

出版信息

Open Access Maced J Med Sci. 2019 Jun 15;7(11):1768-1773. doi: 10.3889/oamjms.2019.547.

DOI:10.3889/oamjms.2019.547

PMID:31316656

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6614275/

Abstract

BACKGROUND

Venoarterial extracorporeal membranous oxygenation is a form of temporary mechanical circulatory support that gets as a salvage technique in patients with cardiogenic shock, we intended to evaluate the effect of (VA ECMO) support on hemodynamics and lactate levels in patients with cardiogenic shock.

AIM

The aim of our study is to detect the ability to introduce veno-arterial extracorporeal membranous oxygenation (VA ECMO) as a temporary extracorporeal life support system (ECLS) in our unit, demonstrate the role of ECMO in cardiogenic shock patients regarding improving hemodynamics and microcirculation, and demonstrate the complications and drawbacks in our first center experience regarding VA ECMO.

MATERIAL AND METHODS

This was a single-centre observational study that included 10 patients admitted with cardiogenic shock for which VA ECMO was used as mechanical circulatory support.

RESULTS

The MAP increased after initiation of the support. It was 41.8 ± 9.3 mmHg and 59.5 ± 6.8 mmHg (P = 0.005). The use of VA ECMO support was associated with a statistically significant decrease in the base deficit (-10.6 ± 4.2 and -6.3 ± 7.4, P = 0.038). The serum lactate declined from 5.9 ± 3.5 mmoL/L to 0.6 ± 4.4 mmoL/L by the use of VA ECMO; a statistically significant change (P = 0.005).

CONCLUSIONS

We concluded that VA ECMO as mechanical support for patients with cardiogenic shock might improve mean arterial blood pressure, base deficit and lactate clearance.

摘要

背景

静脉-动脉体外膜肺氧合是一种临时机械循环支持形式，作为心源性休克患者的挽救技术，我们旨在评估静脉-动脉体外膜肺氧合（VA ECMO）支持对心源性休克患者血流动力学和乳酸水平的影响。

目的

我们研究的目的是检测在我们科室引入静脉-动脉体外膜肺氧合（VA ECMO）作为临时体外生命支持系统（ECLS）的能力，证明ECMO在改善心源性休克患者血流动力学和微循环方面的作用，并展示我们第一个中心在VA ECMO方面的经验中的并发症和缺点。

材料与方法

这是一项单中心观察性研究，纳入了10例因心源性休克入院并使用VA ECMO作为机械循环支持的患者。

结果

支持开始后平均动脉压升高。分别为41.8±9.3 mmHg和59.5±6.8 mmHg（P = 0.005）。使用VA ECMO支持与碱缺失的统计学显著降低相关（-10.6±4.2和-6.3±7.4，P = 0.038）。通过使用VA ECMO，血清乳酸从5.9±3.5 mmol/L降至0.6±4.4 mmol/L；有统计学显著变化（P = 0.005）。