超声心动图监测体外膜式氧合治疗心源性休克的价值

摘要

目的 探讨超声心动图监测体外膜式氧合(ECMO)治疗心源性休克(CS)的价值.方法 选取2013年1月至2015年12月在武汉亚洲心脏病医院使用ECMO辅助治疗并成功脱机的CS患者21例.应用超声心动图分别在ECMO建立前、ECMO流量减半时、ECMO停机后即刻测量左心室射血分数(LVEF)及Tei指数,同时记录肱动脉收缩压(SBP)、动脉血氧饱和度(SaO2).采用单因素方差分析比较接受ECMO辅助治疗且成功撤机的21例患者ECMO建立前、流量减半时、撤离后即刻LVEF、Tei指数、SBP、SaO2差异,进一步组间两两比较采用LSD-t检验;采用配对样本f检验比较接受ECMO辅助治疗且成功撤机的21例患者ECMO建立前与撤离后即刻心率、左心室前后径、下腔静脉宽度、下腔静脉塌陷率、肺动脉楔压、中心静脉压差异.结果 与ECMO建立前比较,接受ECMO辅助治疗且成功撤机的21例患者ECMO流量减半时、ECMO撤离后即刻LVEF均增加,Tei指数均降低,且差异均有统计学意义(LVEF:t=31.952、59.404,P均＜0.01;Tei指数:t=34.406、58.969,P均＜0.01).与ECMO建立前比较,接受ECMO辅助治疗且成功撤机的21例患者ECMO撤离后即刻SBP、SaO2、下腔静脉塌陷率均增大,左心室前后径、肺动脉楔压、中心静脉压均减小,且差异均有统计学意义(t=7.382、37.785、-11.286、3.294、13.923、16.971,P＜ 0.01或0.05);心率、下腔静脉宽度差异均无统计学意义.结论 在应用ECMO治疗CS患者时,超声心动图能对CS患者心脏进行有效监测、为临床判断ECMO疗效、掌握撤机时机提供重要心脏功能参数.%Objective To investigate the value of echocardiography in monitoring the treatment of extracorporeal membrane oxygenation (ECMO) in patients with cardiogenic shock (CS).Methods A total of 21 patientss were included into the present study,who were treated by ECMO due to CS in Wuhan Asia Heart Hospital from January 2013 to December 2015.The left ventricular ejection fraction (LVEF) and Tei index were measured by echocardiography before,in the middle of (flow reduced to one half)and immediately after the process of ECMO.The systolic blood pressure (SBP) and the arterial oxygen saturation (SaO2) were also recorded,and the parameters were compared.The differences of LVEF,Tei index,SBP and SaO2 among different phases of ECMO were compared by using one-way ANOVA and LSD-t test.The differences of heart beat rate,the diameters of left ventricle,diameters of inferior vena cava,subsidence rate of inferior vena cava,pulmonary capillary wedge pressure and central venous pressure among different phases of ECMO were also compared by paired-samples t test.Results Compared with the pre-ECMO level,the LVEF increased during and immediately after the ECMO (t=31.952,59.404,both P ＜ 0.01),while the Tei index decreased significantly (t=34.406,58.969,both P ＜ 0.01).Compared with the pre-ECMO level,the SBP,SaO2 and subsidence rate of inferior vena cava all increased during and immediately after the ECMO,while the diameter of left ventricle,pulmonary capillary wedge pressure and central venous pressure all decreased significantly (t=7.382,37.785,-11.286,3.294,13.923,16.971,all P ＜ 0.01 or 0.05).In contrast,there was no significant change for the parameters of heart beat rate and diameter of inferior vena cava.Conclusion When treating CS patients with ECMO,the echocardiography can monitor the cardiac function effectively,and provide important parameters for the clinical doctors to estimate the ECMO efficacy and decide the weaning time.