作为通往心脏手术的桥梁,ECMO:稳定不稳定的患者进行最终手术
Jai Raman1, Pankaj Saxena2, Nikola Dobrilovic3
1Department of Cardiothoracic Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Australia.
Indian journal of thoracic and cardiovascular surgery
|August 1, 2023
概括
预防性体外膜氧化 (ECMO) 在心脏手术前稳定心脏性休克患者. 这种方法显著降低了术后死亡风险,允许更安全的手术干预.
科学领域:
- 心血管外科心血管外科
- 关键护理医学 关键护理医学
- 机械循环支持 机械循环支持
背景情况:
- 患有心脏性休克和手术可纠正的心脏病的成年人面临高的术后发病率和死亡率.
- 体外膜氧化 (ECMO) 通常用于心脏切除术后的血液动力衰退.
研究的目的:
- 评估一种先发制人的策略,即在心脏外科手术前在心脏性休克患者中启动ECMO.
- 评估手术前ECMO对患者结果和手术风险的影响.
主要方法:
- 在2011年至2021年期间接受了手术前外周静脉动脉 (VA) ECMO的20名心脏性休克患者的回顾性分析.
- 心脏外科手术是通过中间骨切除术进行的,在心肺绕道中使用现场ECMO管进行心肺绕道.
主要成果:
- 20名患者中有15人存活到出院,30天和住院死亡率为25% (与EuroSCORE II预计的67%相比).
- 在平均支持时间为156小时后,有17名患者在ECMO中成功断奶.
- 死亡原因包括出血,肝功能障碍,血小板数低,多器官衰竭等.
结论:
- 手术前的ECMO支持为心脏性休克患者提供了至关重要的血液动力稳定性.
- 及时设立ECMO可以预防或逆转多器官功能障碍,使心脏手术具有可接受的风险.
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