体外膜肺氧合在经皮冠状动脉介入治疗围术期并发心原性休克中的临床应用  

Using extracorporeal membrane oxygenation to rescue cardiogenic shock during the perioperative period of percutaneous coronary intervention in coronary atherosclerotic heart disease patients

作　　者：杜中涛[1] 邢家林[1] 杨峰[1] 江春景[1] 缪娜[1] 刘锋[1] 杨晓芳[1] 黄连军[2] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心体外循环与机械辅助循环科,北京100029 [2]首都医科大学附属北京安贞医院心脏外科危重症中心介入诊疗科,北京100029

出　　处：《中国介入心脏病学杂志》2015年第10期564-567,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的总结体外膜肺氧合(ECMO)治疗冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入治疗(PCI)围术期发生心原性休克的临床经验。方法回顾分析北京安贞医院心脏外科危重症中心2012年1月至2015年2月,9例患者因为PCI围术期发生心原性休克而应用动静脉ECMO支持。使用适应证包括大剂量的血管活性药物应用和(或)应用主动脉内球囊反搏(IABP)仍难以维持血流动力学稳定或PCI围术期发生难以复律的心搏骤停。回顾性分析9例患者的临床资料,包括患者基本情况、ECMO应用时机和后续治疗等。并根据住院结果及后续治疗策略进行分组比较。结果患者中位年龄为56(32,62)岁,其中男6例(66.7%)。在9例患者中,5例(55.6%)患者ECMO后进行了再血管化处理,其中4例(80.0%,4/5)顺利康复出院;另外4例患者进行了恢复性治疗,其中2例(50.0%,2/4)顺利康复出院。ECMO支持中位时间114.0(20.0,245.0)h。总共有7例(77.8%)患者成功脱离ECMO辅助,6例(66.7%)患者顺利康复出院。结论对PCI围术期心原性休克采用ECMO维持循环进行再血管化或过渡到恢复是可行的。Objective To summarize the clinical experience of extracorporeal membrane oxygenation （ECMO） support for coronary atherosclerotic heart disease patients with cardiogenie shock during the perioperative period of pereutaneous coronary intervention （PCI） . Methods We review our hospital experience regarding ECMO use on those who developed cardiogenic shock during the perioperative period of percutaneous coronary intervention （PCI） in coronary atherosclerotic heart disease （CAD） patients between January 2012 and February 2015. Indications for support included： refractory cardiogenic shock despite adequate filling volumes, large-dose inotropes and/or intra-aortic balloon pump support or refractory cardiac arrest during PCI. Results The median age was 56 （32, 62） years old with six men and three women. Among the 9 patients, 5 patients underwent revascularization （PCI = 2, CABG = 2 and PCI ＋ CABG = 1 ） and 4 patients were bridged to recovery. The median time of using ECMO was 114 （20, 245 ） hours. 7 （77. 8% ） patients successfully weaned from ECMO and 6 （66.7%） patients discharged alive. Conclusions ECMO support for revascularization or bridge to recovery is practical in cardiogenic shock patients during the perioperative period of PCI.

关 键 词：体外膜肺氧合 经皮冠状动脉介入治疗 心原性休克 

分 类 号：R541.4[医药卫生—心血管疾病]