主动脉内球囊反搏联合体外膜肺氧合对于急性心肌梗死合并心源性休克患者的疗效及相关影响因素分析  

Efficacy and Related Inflencing Factors of Intra-aortic Balloon Counterpulsation Combined with Extracorporeal Membrane Oxygenation in Patients with Acute Myocardial Infarction and Cardiogenic Shock

作　　者：芮子傲 戴东普[1] 郭影影 庞硕 周远航 杜洋 赵晓燕[1] 董建增[1] RUI Ziao;DAI Dongpu;GUO Yingying;PANG Shuo;ZHOU Yuanhang;DU Yang;ZHAO Xiaoyan;DONG Jianzeng(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院,河南省郑州市450052

出　　处：《中国全科医学》2022年第21期2597-2604,共8页Chinese General Practice

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2018YFC1312505);河南省科技攻关项目(212102310210)。

摘　　要：背景急性心肌梗死(AMI)合并心源性休克(CS)是心内科常见的急危重症,及时有效的血流动力学支持是挽救这类患者生命的重要手段之一,研究主动脉内球囊反搏(IABP)联合体外膜肺氧合(ECMO)对这类患者的疗效具有重要的临床意义。目的探讨IABP联合ECMO对AMI合并CS患者的疗效,AMI合并CS患者需要ECMO支持的影响因素。方法选取2014年10月至2020年10月郑州大学第一附属医院冠心病监护病房(CCU病房)住院的应用IABP救治的AMI合并CS患者91例为研究对象,根据有无应用ECMO分为IABP组(n=65)及IABP+ECMO组(n=26)。收集并分析两组患者的临床资料,随访患者出院12个月生存率,采用多因素Logistic回归分析探讨患者应用ECMO的影响因素。结果IABP组IABP后心搏骤停比例、24 h血管活性药物评分(VIS)水平、连续肾脏替代疗法(CRRT)、气管插管应用比例、肺部感染比例、下肢缺血比例、急性肾损伤比例、消化道出血比例、出院后12个月生存率、肾上腺素、去甲肾上腺素应用比例低于IABP+ECMO组(P<0.05),CCU住院时间短于IABP+ECMO组(P<0.05),年龄高于IABP+ECMO组(P<0.05)。双因素重复测量方差分析结果显示:时间和组别对收缩压、舒张压、心率不存在交互作用(P>0.05),时间和组别对乳酸、pH值存在交互作用(P<0.05);时间对收缩压、舒张压、乳酸、pH值主效应显著(P<0.05),时间对心率主效应不显著(P>0.05);组别对收缩压、舒张压、心率、乳酸、pH值主效应不显著(P>0.05)。其中两组治疗后24 h、72 h收缩压、pH值均高于上机前,乳酸水平低于上机前;两组治疗后72 h收缩压、pH值高于治疗后24 h,乳酸水平低于治疗后24 h(P<0.05)。IABP组治疗后24 h、72 h舒张压均高于上机前(P<0.05)。IABP+ECMO组治疗后72 h收缩压高于IABP组(P<0.05);IABP+ECMO组治疗后24 h的乳酸水平低于IABP组,pH值高于IABP组(P<0.05)。多因素Logistic回归分析显示,年龄、治疗后24 h VIS、IABP后Background Acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)is a common emergency and severe disease in the department of cardiology.Timely and effective hemodynamic support is one of the important means to save the lives of such patients.Research on intraaortic balloon pumping(IABP)combined with extracorporeal membrane oxygenation(ECMO)had important clinical significance for the efficacy of these patients.Objective To explore the efficacy of IABP combined with ECMO in patients with AMI and CS and the inflencing factor of the need for ECMO support in patients with AMI and CS.Methods A total of 91 patients with AMI and CS treated with IABP in the Coronary Care Unit(CCU ward)of the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2020 were collected and divided into IABP group(n=65)and IABP+ECMO group(n=26)according to the use of ECMO.The clinical data of the patients in both groups were collected and analyzed.The 12-months survival rate of patients discharged from hospital was followed up.The inflecting factors of AMI patients complicated with CS treated with IABP needed ECMO support by Multivariate logistic regression analysis.Results Rate of cardiac arrest after IABP,VIS level at 24 h,survival rate at 12 months after discharge and proportion of continuous renal replacement therapy(CRRT),tracheal intubation,pulmonary infection,lower extremity ischemia,acute kidney injury and gastrointestinal bleeding,12-month survival rate after discharge,the use ratio of epinepHrine and norepinepHrine in IABP group were lower than those in IABP+ECMO group(P<0.05).And the duration of CCU hospitalization in IABP group was shorter than that of IABP+ECMO group(P<0.05).Age in IABP group was higher than that of IABP+ECMO group(P<0.05).The results of two-factor repeated measures Anova showed that the group and time had no significant interaction effects on systolic blood pressure,diastolic blood pressure and heart rate(P>0.05).The group and time had significant interaction effects on l

关 键 词：心肌梗死 休克 心源性 心血管疾病 主动脉内球囊反搏术 体外膜肺氧合 血管活性药物评分 

分 类 号：R542.22[医药卫生—心血管疾病]