总结心脏移植受者围手术期应用体外膜肺氧合(ECMO)的单中心经验。

回顾性分析2012年6月至2018年4月于解放军第924医院行心脏移植且围手术期接受ECMO辅助的19例受者临床资料。男性15例，女性4例，平均年龄(42±8)岁，平均体质量(58±8) kg。原发病包括扩张型心肌病13例，缺血性心肌病2例，瓣膜性心肌病2例，以及致心律失常型右室心肌病和限制型心肌病各1例。术前平均左心室射血分数(24±7)%，平均肺动脉收缩压(48±7) mmHg。供受者体质量相差均<20%，供心冷缺血时间平均(92±25) min。

19例受者中，ECMO术前植入1例，术中植入15例，术后植入3例。ECMO转流时间(73±36) h。5例受者因心功能无改善无法撤机，最终放弃治疗，其中2例出现消化道出血被迫撤机。其余14例受者顺利撤机，其中3例受者撤机后分别因感染、急性排斥反应和多器官功能衰竭死亡。并发症包括：膜肺渗漏5例，床旁开胸止血8例，下肢缺血2例，急性肾损伤13例，急性肝衰竭2例，消化道出血4例，肺部感染1例。6例受者联合使用主动脉内球囊反搏辅助。

ECMO在心脏移植围手术期的应用效果良好，早期积极应用是其成功的关键。

To summarize the single-center experience of extracorporeal membrane oxygenation (ECMO) application in heart transplantation recipients during perioperative period.

The clinical data of 19 recipients who underwent heart transplantation and received ECMO assist during the perioperative period at the Chinese People′s Liberation Army No.924 Hospital from June 2012 to April 2018 were retrospectively analyzed. Among them, 15 recipients were male and 4 recipients were female, with an average age of (42±8) years and an average weight of (58±8) kg. The primary diseases included 13 cases of dilated cardiomyopathy, 2 of ischemic cardiomyopathy, 2 of valvular cardiomyopathy, 1 of arrhythmogenic right ventricular cardiomyopathy and 1 of restrictive cardiomyopathy. The average preoperative left ventricular ejection fraction was (24±7)%, and the average pulmonary artery systolic pressure was (48±7) mmHg. There were 18 male donors and 1 female donor. The body weight difference between the donor and recipient was within ±20%. The cold ischemia time of the donor heart was (92±25) min.

Among the 19 recipients, 1 received ECMO before transplantation, 15 received ECMO during transplantation and 3 received ECMO after transplantation. The ECMO bypass time was (73±36) h. Five recipients could not be withdrawn from the ECMO due to lack of improvement in cardiac function and eventually gave up the treatment, and 2 of them had gastrointestinal bleeding and were forced to withdraw from the ECMO. The remaining 14 cases were successfully withdrawn from the ECMO, 3 of them died of infection, acute rejection and multiple organ failure after weaning. Complications included 5 cases of membrane lung leakage, 8 of bedside thoracotomy to stop bleeding, 2 of lower limb ischemia, 13 of acute kidney injury, 2 of acute liver failure, 4 of gastrointestinal bleeding, and 1 of lung infection. Six recipients were combined with intra-aortic balloon counterpulsation.

ECMO has a good effect in the perioperative period of heart transplantation and can reduce the mortality of patients with severe heart transplantation. Early active application is the key to its success.