摘要
目的:观察动-静脉体外膜肺氧合(VA-ECMO)联合主动脉内球囊反搏(IABP)对急性心肌梗死PCI术后合并难治性心源性休克患者的临床疗效及转归。方法:回顾性分析2019年12月—2021年4月我院心内科收治的急性心肌梗死PCI术后合并难治性心源性休克同时接受VA-ECMO及IABP治疗的11例患者,收集并观察临床基线资料、冠状动脉(冠脉)病变特点及介入治疗情况、辅助治疗前后血流动力学变化、血管活性药物使用情况、血气分析指标变化情况、ECMO生存评分(SAVE评分)、术后并发症及临床结局等。结果:11例患者当中,VA-ECMO及IABP治疗前后心脏指数(CI)、平均动脉压(MAP)、心率(HR)、心脏射血分数(EF)、血管活性药物使用剂量、乳酸(Lac)、混合静脉氧饱和度(SvO;)指标差异有统计学意义(P<0.05)。其中院内死亡3例,存活8例,存活率72.7%,发生消化道大出血2例(18.2%),急性肾衰竭2例(18.2%),重度感染1例(9.1%),脑出血1例(9.1%)。结论:VA-ECMO联合IABP可为急性心肌梗死并难治性心源性休克患者提供有效循环支持,在改善重要脏器功能及纠正心源性休克、代谢性酸中毒中起重要作用,同时准确把握VA-ECMO及IABP的使用时机及预防并发症出现可有效提高治疗成功率。
Objective: To observe the clinical efficacy and outcome analysis of venoarterial extracorporeal membrane oxygenation(VA-ECMO) combined with intra-aortic balloon counterpulsation(IABP) in patients with acute myocardial infarction combined with refractory cardiogenic shock after PCI. Methods: A retrospective analysis of 11 patients were analyzed in acute myocardial infarction combined with refractory cardiogenic shock treated with VA-ECMO and IABP after PCI in the Department of Cardiology of our hospital from December 2019 to April 2021. Clinical baseline data were collected and observed, such as coronary artery disease characteristics and interventional treatment, hemodynamic changes before and after adjuvant treatment, vasoactive drug use, changes in blood gas analysis indicators, ECMO survival score(SAVE score), postoperative complications and clinical outcomes. Results: In 11 patients, the differences were statistically significant in degree(SvO;) index, cardiac index(CI), mean arterial pressure(MAP), heart rate(HR), cardiac ejection fraction(EF), vasoactive drug dosage, lactic acid(Lac), mixed venous oxygen saturation before and after VA-ECMO and IABP treatment(P<0.05). Among them, 3 cases died in the hospital, 8 cases survived with survival rate(72.7%). The 2 cases were gastrointestinal hemorrhage(18.2%), 2 cases were acute renal failure(18.2%), 1 case was severe infection(9.1%), and 1 case was cerebral hemorrhage(9.1%). Conclusion: VA-ECMO combined with IABP can provide effective circulatory support for acute myocardial infarction and refractory cardiogenic shock, and play an important role in improving the function of important organs and correcting cardiogenic shock and metabolic acidosis.
作者
廖付军
鲍海龙
韦波
谢登海
李洁琪
李伟
LIAO Fujun;BAO Hailong;WEI Bo;XIE Denghai;LI Jieqi;LI Wei(Department of Cardiology,the Affiliated Hospital of Guizhou Medical University,Guiyang,550001,China;Guizhou Medical University)
出处
《临床心血管病杂志》
CAS
北大核心
2021年第11期992-997,共6页
Journal of Clinical Cardiology
基金
国家自然科学基金项目(No:81960047)
贵州省科技计划项目(No:黔科合支撑[2021]一般063)。
关键词
难治性心源性休克
主动脉球囊反搏
体外膜肺氧合
急性心肌梗死
refractory cardiogenic shock
intra-aortic balloon pump
extracorporeal membrane oxygenation
acute myocardial infarction
