急性心肌梗死并发心脏骤停在体外膜肺氧合支持下的介入治疗  

Extracorporeal membrane oxygenation supports primary percutaneous intervention for acute myocardial infarction with cardiac arrest

作　　者：张励庭[1] 袁勇[1] 黄炫生[1] 冯力[1] 董剑廷[1] 刘卫其[1] 韩莹[1] 邓志华[1] 张劲[1] 李斌飞[1] 张志刚[1] 谢钢[1] 

机构地区：[1]中山大学附属中山医院中山市人民医院心内科,广东中山528403

出　　处：《岭南心血管病杂志》2008年第4期241-243,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的评价急性心肌梗死并发心脏骤停在体外膜肺氧合(extra corporeal membrane oxygenation,ECMO)辅助下行急诊介入治疗的可行性和有效性。方法急性心肌梗死并发心搏和呼吸骤停4例,男,年龄37～69岁,其中急性广泛前壁心肌梗死3例,到医院后均出现心搏和呼吸骤停,心电图示心室颤动;另1例为急性下壁和正后壁心肌梗死,并发Ⅲ度房室传导阻滞和心室颤动。4例病人经常规心肺复苏术和高级生命支持后仍反复发生恶性心律失常,不适合应用主动脉内球囊反搏,血流动力学极不稳定,应用ECMO行循环呼吸支持,并进行急诊介入治疗。结果在ECMO辅助后,4例患者心电和血流动力学较前稳定后,送导管室行急诊冠状动脉介入。造影提示单支血管病变和双支血管病变各1例,三支血管病变2例,梗死相关血管为左前降支3例,右冠状动脉1例,均成功进行介入治疗并植入支架。急诊介入治疗后,在心电和血流动力学稳定后撤除ECMO。ECMO支持时间5～28h(平均18h)。痊愈出院3例,另1例在撤除ECMO后因心脏功能衰竭死亡。结论ECMO可对急性心肌梗死合并恶性心律失常和血流动力学不稳定的病人提供有效的循环呼吸支持,为冠状动脉介入提供条件,提高抢救成功率可行和有效。Objectives To evaluate the efficacy and safety of extracorporeal membrane oxygenation （ECMO） in percutaneous coronal w intervention （PCl） for acute myocardial infarction （AMI） with cardiac arrest. Methods A retrospective analysis was performed on 4 patients underwent primary PCI with ECMO. After continual resuscitation and advanced life support （ALS） , four cases of AMI with cardiac arrest and recurrented lethal arrhythmias, were in unstable hemodynamic status and were unsuitable for intra-aortic balloon pump. Results ECMO were set up at bedside successfully. In support of ECMO, coronary angiography and PCI were performed successfully. Coronary angiography showed one case with single vessel disease, one cases with double vessel disease, and two cases with triple vessel disease. The infarct-related arteries reflowed after stent implantation. The duration of ECMO support were from 5 hours to 28 hours. Three patients discharged with fully recovered. One patient with triple vessel disease died of left heart failure. Conclusions ECMO plays role in life saving in patients with AMI complicated cardiac arrest and lethal arrhythmias who fail to improve or stabilize with conventional therapy. ECMO in primary PCI for AMI with cardiac arrest is feasible and safe.

关 键 词：体外膜肺氧合 急性心肌梗死 心脏骤停 血管成形术 经皮 经腔 冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病] R543.3[医药卫生—内科学]