体外膜肺氧合在急性心肌梗死合并心搏骤停患者中应用的单中心经验  

Single-center experience of extracorporeal membrane oxygenation in patients with acute myocardial infarction complicated with cardiac arrest

作　　者：潘晨亮[1] 赵晶[1] 张博[1] 卢安东 白明[1] PAN Chen-liang;ZHAO Jing;ZHANG Bo;LU An-dong;BAI Ming(Heart Center,the First Hospital of Lanzhou University,Gansu Key Laboratory for Cardiovascular Diseases of Gansu Province,Cardiovascular Clinical Research Center of Gansu Province,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院心脏中心,甘肃省心血管疾病重点实验室,甘肃省心血管病临床医学研究中心,甘肃兰州730000

出　　处：《中国介入心脏病学杂志》2022年第11期819-824,共6页Chinese Journal of Interventional Cardiology

基　　金：甘肃省科技重点研发计划项目(21YF5FA118);甘肃省青年科技基金计划项目(21JR7RA385)。

摘　　要：目的总结分析应用体外膜肺氧合(ECMO)救治急性心肌梗死合并心搏骤停患者的临床特点及预后。方法回顾性纳入2020年1月至2022年2月兰州大学第一医院心脏中心应用ECMO联合心肺复苏(CPR)救治急性心肌梗死合并有目击的心搏骤停患者22例,按照院内结局分为存活组6例和死亡组16例,比较两组患者临床情况。结果所有患者平均年龄(62.1±10.0)岁,其中女2例(2/22),死亡组患者心搏骤停前出现心原性休克的比例高于存活组(P=0.046);所有患者中有11例(11/22)患者的罪犯血管为左前降支,有11例(11/22)患者的罪犯血管术前心肌梗死溶栓治疗试验(TIMI)血流分级0级,有11例(11/22)患者的冠状动脉病变≥2支,有5例(5/22)患者合并冠状动脉慢性闭塞,中位支架置入数目1.0(1.0,2.0)枚;神经元特异性烯醇化酶在存活组明显低于死亡组[33.4(24.8,38.8)mmol/L比80.8(58.7,240.0)mmol/L,P=0.012];存活出院的6例患者中,其中格拉斯哥-匹兹堡脑功能表现分级(CPC)1~2级患者有5例(5/6),CPC 3~5级患者有1例(1/6);30 d内6例患者均存活。结论ECMO联合CPR联合急诊经皮冠状动脉介入治疗,可作为胸痛中心流程中对急性心肌梗死合并心搏骤停患者救治的有效策略,可能改善患者的预后,对此类患者神经功能损伤的恢复需要重点关注。Objective To summarize the clinical characteristics and prognosis of patients with acute myocardial infarction complicated with cardiac arrest treated by extracorporeal membrane oxygenation(ECMO).Methods Twenty-two patients with acute myocardial infarction complicated with witnessed cardiac arrest treated by ECMO in the chest pain center of the First Hospital of Lanzhou University from January 2020 to February 2022 were retrospectively enrolled,and they were divided into the survival group(n=6)and the death group(n=16)according to hospital outcomes.Results The mean age of the patients was(62.1±10.0)years,including two females(2/22).The proportion of cardiogenic shock before cardiac arrest in the death group was higher than that in the survival group(P=0.046).Among all patients,there were eleven cases(11/22)of culprit vessels with anterior descending artery lesions,eleven cases(11/22)of culprit vessels with preoperative TIMI grade 0,eleven cases(11/22)had more than 2 coronary artery lesions,and five cases(5/22)of culprit vessels with chronic coronary artery occlusion.The median number of stents placed was 1.0(1.0,2.0).Neuron specific enolase(NSE)in the survival group was significantly lower than that in the death group[33.4(24.8,38.8)mmol/L vs.80.8(58.7,240.0)mmol/L,P=0.012].Among the patients who survived discharge,there were five patients(5/6)with the Glasgow-Pittsburgh cerebral performance category(CPC)1-2 and one(1/6)with CPC 3-5.Six patients survived within 30 days of follow-up.Conclusions ECMO combined with CPR and primary percutaneous coronary intervention can be used as an effective strategy for the treatment of patients with acute myocardial infarction complicated with cardiac arrest in the chest pain center process,and may improve the prognosis of these patients.The recovery of neurological injury in such patients needs to be paid more attention.

关 键 词：急性心肌梗死 心搏骤停 心肺复苏 体外膜肺氧合 

分 类 号：R541[医药卫生—心血管疾病]