实用医学杂志 ›› 2022, Vol. 38 ›› Issue (24): 3135-3140.doi: 10.3969/j.issn.1006⁃5725.2022.24.020

• 临床研究 • 上一篇    下一篇

ECMO在危急重症心脏病孕产妇救治中的应用体会 

陈乐1 邱依聆2 江燕萍1    

  1. 1 广东省人民医院(广东省医学科学院)产科(广州 510080);2 暨南大学附属广州红十字会医院 (广州 510240)

  • 出版日期:2022-12-25 发布日期:2022-12-25
  • 通讯作者: 江燕萍 E⁃mail:doctor.jyp@163.com
  • 基金资助:
    广州市产学研协同创新重大专项民生科技研究(科技帮扶)项目(编号:201604020008)

Experience of implementing extracorporeal membrane oxygenation in the management of pregnant females complicated with critical cardiovascular diseases 

CHEN Le*,QIU Yiling,JIANG Yanping.    

  1. Depart⁃ ment of Obstetrics,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China 

  • Online:2022-12-25 Published:2022-12-25
  • Contact: JIANG Yanping E⁃mail:doctor.jyp@163.com

摘要:

目的 探讨体外膜肺氧合(ECMO)在危急重症心脏病孕产妇救治中的应用价值。方法 过检索医院病历系统,回顾性分析自 2014 1 月至 2022 9 月在广东省人民医院应用 ECMO 救治的所有 危急重症心脏病孕产妇的临床资料,数据采用 SPSS17.0 统计软件进行处理。结果 共检索到使用 ECMO 救治的危急重症心脏病孕产妇 6 例,包括妊娠合并重度肺高压 3 例(特发性肺高压 2 例、风湿性心脏病重 度二窄并肺高压1例)、妊娠合并重症心肌炎1例、围产期心肌病1例,中位孕周29周(7⁃32周);经产妇2 (均曾经顺产一胎)、首次怀孕 3 例、第二次怀孕 3 例;3 例进入围产期病例经剖宫产终止妊娠、1 例经产妇 早产急产顺产、1 例早孕行人流术、1 例中孕行剖宫取胎。使用 ECMO 指征分别是肺高压危象、心源性休克 和呼吸心跳骤停。中位 ECMO 维持时间 7 d(4 ~ 16 d);使用 ECMO 的主要并发症有出血(3/6)、感染(3/6)、 多器官功能衰竭(MODS,3/6)和血栓形成(2/6),5 例同时存在两种并发症。4 例患者成功撤离 ECMO 并存 活,平均住院天数 28.25 d。孕产妇死亡 2 例,死亡原因是感染或出血继发 MODS。4 例围产儿均存活,预后 良好。结论 通过加强围产期管理,积极掌握适宜的使用指征和多学科协作,ECMO 可以提供有效的生命 支持,降低孕产妇和围产儿死亡,在妊娠合并危急重症心脏病孕产妇的救治中,ECMO 具有改善母儿结局、 挽救孕产妇的生命的重要价值。

关键词:


体外膜肺氧合, 急危重症, 妊娠合并心脏病, 孕产妇

Abstract:

Objective Investigate the clinical efficacy of extracorporeal membrane oxygenation(ECMO) in the management of pregnant females complicated with critical cardiovascular diseases. Methods Clinical data of 6 pregnant patients with critical cardiovascular diseases treated by ECMO from 1 Jan 2014 to 30 Sept 2022 in our institution were analyzed by SPSS17.0 statistical software. Results 6 patients received ECMO. Patients′ ages ranged from 19 to 32 years old(median age 23.5 years old). Gestation transferred ranged from 7 to 32 weeks(median gestation week was 29 weeks). 3 patients were primigravid. 3 patients were in their second pregnancy,2 of which had a previous history of vaginal delivery. 3 patients were complicated with severe pulmonary hypertension,2 of which were idiopathic,and the other was secondary to rheumatic valvular heart disease. Other patients were compli⁃ cated with acute severe myocarditis,peripartum cardiomyopathy,and acute pulmonary heart disease respectively. Cesarean sections were performed in 3 patients and hysterotomy was performed in one patient. A multi⁃para patient had a spontaneous preterm delivery and a patient had an artificial abortion. Indications for ECMO were pulmonary hypertensive crisis ,cardiogenic shock ,and cardiopulmonary arrest. The duration of ECMO ranged from 4 to 16 days(median duration 7 days). Major complications of ECMO included hemorrhage(3/6),infection(3/6), multiple organs dysfunction syndrome(MODS,3/6),and thrombosis(2/6). 5 patients suffered two of the above. 4 patients survived after ECMO with an average hospital stay of 28.25 days,and 2 patients died of MODS compli⁃ cated with severe infection or hemorrhage. 4 neonates survived with a good prognosis. Conclusions With the man⁃ agement of the multidisciplinary team,the timely application of ECMO in appropriate cases could provide sufficient life support and contribute to better maternal and fetal outcomes. Particularly in obstetric patients with critical car⁃ diovascular diseases,ECMO may play a vital role in the salvage treatment.

Key words:

pregnancy , postpartum , extracorporeal membrane oxygenation , cardiovascular diseases ,