目的: 利用床旁经胸超声心动图对暴发性心肌炎与心肌梗死后行VA-ECMO支持患者的左心收缩功能进行评估,探讨床旁超声心动图在VA-ECMO支持治疗时的应用价值。方法: 回顾性分析在我院行VA-ECMO支持的患者32例,选取心源性休克并成功撤机的患者16例,分为暴发性心肌炎（8例）、心肌梗死（8例）两组,对两组内和两组间的一般临床资料以及VA-ECMO支持建立前、建立后24h和成功撤机后的左房内径（LAD）、左室舒张末期内径（LVDD）及射血分数（LVEF）进行对比。结果: （1）一般临床资料比较：较心肌梗死组平均年龄（64.1±6.9岁）,暴发性心肌炎组的平均年龄（34.2±9.0岁）更小。（2）组内比较：暴发性心肌炎组LVDD在VA-ECMO支持建立前平均水平（42.9±9.5）mm低于建立后24h平均水平（46.7±8.8）mm;成功撤机后LVEF平均水平（51.5±21.3）%高于建立后24h平均水平（33.9±18.4）%。心肌梗死组在VA-ECMO支持建立前、建立后24h、成功撤机后的LAD、LVDD及LVEF组内比较均无统计学差异。（3）两组间对比：暴发性心肌炎组LAD在VA-ECMO支持建立前、建立后24h和成功撤机后均低于急性心肌梗死组;VA-ECMO支持建立前心肌梗死组LVDD平均水平大于暴发性心肌炎组;成功撤机后暴发性心肌炎组的LVEF高于急性心肌梗死组。结论: VA-ECMO支持可以明显改善暴发性心肌炎组患者的LVEF,暴发性心肌炎对心功能的影响可能可逆;VA-ECMO支持对心肌梗死组LAD、LVDD、LVEF的改善不明显,但可以为其他目的的治疗争取一段时间;暴发性心肌炎组LAD在VA-ECMO支持建立前、建立后24h和成功撤机后转出ICU前均低于急性心肌梗死组;年龄、LAD、LVDD可能影响心功能的恢复。
Abstract
Objective To evaluate the left ventricular systolic function of patients with fulminant myocarditis and myocardial infarction during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy using bedside transthoracic echocardiography, so as to explore the application value of bedside echocardiography during VA-ECMO therapy. Methods A retrospective analysis was carried out on 32 patients undergoing VA-ECMO support in our hospital. Sixteen patients with cardiogenic shock and successful weaning were selected and divided into two groups: the fulminant myocarditis group (n=8) and the myocardial infarction group (n=8). Further inter-group and intra-group comparisons were performed on the general clinical data, left atrial diameter (LAD), left ventricular end-diastolic diameter (LVDD), and left ventricular ejection fraction (LVEF) before VA-ECMO support, 24 hours after VA-ECMO support, and after the successful weaning, respectively. Results (1) Comparison of general clinical data: The average age of the fulminant myocarditis group was smaller than that of the myocardial infarction group [(34.2±9.0) vs. (64.1±6.9) years]. (2) Comparison within groups: The average level of LVDD before VA-ECMO support establishment in explosive myocarditis group was lower than that after 24h (46.7±8.8) mm. The average level of LVEF after successful weaning was higher than that 24 hours after VA-ECMO support [ (51.5±21.3) % vs. (33.9±18.4) %]. Furthermore, in the myocardial infarction group, there were no significant differences in LAD, LVDD and LVEF before VA-ECMO support was established, 24h after VA-ECMO support was established, and after successful withdrawal. (3) Comparison between the two groups: The LAD in explosive myocarditis group was lower than that in acute myocardial infarction group before VA-ECMO support was established, 24h after VA-ECMO support was established and after successful withdrawal. The average LVDD level of the myocardial infarction group was higher than that of the fulminant myocarditis group before VA-ECMO support. Besides, The LVEF of explosive myocarditis group was higher than that of acute myocardial infarction group. Conclusions VA-ECMO support can significantly improve LVEF in patients with myocarditis and the impact of fulminant myocarditis on cardiac function is possibly reversible. VA-ECMO support did not significantly improve LAD, LVDD and LVEF in myocardial infarction group, but could buy a period of time for other purposes of treatment. LAD in explosive myocarditis group was lower than that in acute myocardial infarction group before VA-ECMO support was established, 24h after VA-ECMO support was established, and before ICU transfer after successful withdrawal . Age, LAD and LVDD may affect the recovery of cardiac function.
关键词
VA-ECMO /
超声心动图 /
左心功能 /
暴发性心肌炎 /
心肌梗死
Key words
VA-ECMO /
echocardiography /
left ventricular function /
fulminant myocarditis /
myocardial infarction
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参考文献
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基金
淮安市科技项目（HAP202105）; 2020年度省第五期“333工程”科研项目资助计划（BRA2020233）
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