体外膜肺氧合治疗急性暴发性心肌炎合并心源性休克16例临床分析

严凤娣; 吴晓燕; 殷静静; 於江泉; 郑瑞强

doi:10.13201/j.issn.1009-5918.2021.08.002

体外膜肺氧合治疗急性暴发性心肌炎合并心源性休克16例临床分析

- 苏北人民医院重症医学科(江苏扬州, 225001)

详细信息

通讯作者: 郑瑞强,E-mail:13952721411@163.com

中图分类号: R542.21

收稿日期: 2021-04-08

Clinical study of extracorporeal membrane oxygenation in patients with cardiogenic shock after acute fulminant myocarditis

- Department of Critical Care Medicine, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou, Jiangsu, 225001, China

More Information

Corresponding author: ZHENG Ruiqiang, E-mail: 13952721411@163.com

Received Date: 08 April 2021

摘要

摘要: 目的:回顾性分析静脉-动脉体外膜肺氧合(VA-ECMO)对急性暴发性心肌炎(AFM)合并心源性休克(CS)患者的临床治疗效果。方法:回顾性分析2016年6月-2019年12月期间我院重症医学科收治的16例合并CS并接受了VA-ECMO循环辅助的AFM患者的病例资料。根据临床治疗结果分为存活组和死亡组,分析比较两组患者的基线资料,实验室指标包括肌钙蛋白I(cTnI)、CKMB、谷草转氨酶(AST)、BNP、肌酐等,记录有创机械通气、临时起搏器、连续肾脏替代治疗(CRRT)、住院时长以及并发症发生情况等数据。结果:16例患者,其中男9例(56.3%),女7例(43.7%);平均年龄(40±14)岁;存活12例,存活率75%。两组患者在年龄、伴随疾病、有创机械通气、IABP、CRRT及ECMO治疗时长等方面比较,差异无统计学意义(P>0.05)。两组患者血清CKMB、AST、BNP、肌酐水平比较,差异无统计学意义(P>0.05)。两组患者入院时cTnI[存活组vs.死亡组:(10.91±11.02)ng/mL vs.(42.02±24.36)ng/mL,P=0.003]和住院时长[存活组vs.死亡组:(30.67±14.37)d vs.(6.0±4.16)d,P=0.005]间比较,差异有统计学意义。结论:VA-ECMO是临床治疗AFM合并CS患者的有效机械辅助方法。
- 暴发性心肌炎 /
- 心源性休克 /
- 体外膜肺氧合 /
- 肌钙蛋白Ⅰ /
- 肌酸激酶同工酶
Abstract: Objective: To investigate the clinical effect of the extracorporeal membrane oxygenation(ECMO) in acute fulminant myocarditis(AFM) patients with cardiogenic shock(CS).Methods: Clinical data of 16 AFM patients with CS admitted to Critical Care Medicine in Subei People's Hospital and accepted vein-artery extracorporeal membrane oxygenation(VA-ECMO) were retrospectively analyzed from June 2016 to December 2019. The patients were divided into two groups which were the survival group and death group according to the outcome of ECMO. Baseline information, application of mechanical ventilation, temporary pacemaker, continuous renal replacement therapy(CRRT), complications, ECMO supporting time and duration of hospital stay were analyzed. The levels of troponin I(cTnI), creatine kinase isoenzyme MB(CKMB), aspartate aminotransferase(AST), serum creatinine, were compared.Results: The mean age of the 16 patients was(40±14) years, including 7 females(43.7%) and 9 males(56.3%), and 12 patients survived, with a survival rate of 75%. There was no significant difference in age, concomitant disease, invasive mechanical ventilation, IABP, CRRT and ECMO mechanical supporting time between the two groups(P>0.05). The serum lever of CKMB, AST, BNP and creatinine showed no significant difference between groups(P>0.05). The serum lever of cTnI(Survivors vs. Non-survivors: 10.91±11.02 vs. 42.02±24.36, P=0.003) and the length of hospital stay(Survivors vs. Non-survivors: 30.67±14.37 vs.6.0±4.16, P=0.005) were different between the two group.Conclusion: VA-ECMO is an effective method for the treatment of AFM patients with CS. Elevated serum cTnI and CK-MB levels at admission may indicate poor clinical outcomes.
- acute fulminant myocarditis /
- cardiogenic shock /
- extracorporeal membrane oxygenation /
- cTnI /
- creatine kinase isoenzyme MB

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