早期全身CT联合冠状动脉造影术在体外心肺复苏中的应用  

Early whole body CT combined with coronary angiography for treatment guidance in patients with extracorporeal cardiopulmonary resuscitation

作　　者：朱轶 陈旭锋 李伟 张忠满 梅勇 吕金如 胡德亮 张刚 孙峰 张华忠 安迪 邹乐 丁涛 娄爽 Zhu Yi;Chen Xufeng;Li Wei;Zhang Zhongman;Mei Yong;Lv Jinru;Hu Deliang;Zhang Gang;Sun Feng;Zhang Huazhong;An Di;Zou Yue;Ding Tao;Lou Shuang(Emergency Medicine Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院急诊医学中心,南京210029

出　　处：《中华急诊医学杂志》2022年第12期1603-1607,共5页Chinese Journal of Emergency Medicine

基　　金：江苏省“六个一工程”拔尖人才(LGY20190688);江苏省人民医院“511腾飞工程”(2018)。

摘　　要：目的探讨早期全身计算机断层扫描(whole-body computed tomography,WBCT)联合冠状动脉造影(coronary angiography,CAG)检查在体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者中的安全性,及在心脏骤停(cardiac arrest,CA)病因诊断、心肺复苏(cardiopulmonary resuscitation,CPR)并发症等方面的应用价值。方法回顾性收集2017年1月至2021年7月间于南京医科大学第一附属医院急诊科行ECPR的患者,排除标准包括年龄不满18岁及临床资料不全患者,收集ECPR后WBCT及CAG检查结果。结果共89例ECPR患者纳入研究,年龄为(47±17)岁,均行WBCT检查,未发生ECMO及气管插管管路脱落等不良事件。WBCT在病因诊断方面共发现7例肺栓塞、3例主动脉夹层、2例脑出血。WBCT发现42例CPR并发症,包括20例发生肋骨骨折、5例气胸、5例纵膈积气、6例皮下气肿和6例穿刺部位血肿或肿胀。55例行CAG检查,发现7例左主干病变、32例左前降支病变、15例回旋支病变和12例右冠状动脉病变。结论早期WBCT和CAG检查在ECPR患者的病因诊断、CPR并发症、指导治疗方面具有重要意义且安全可行。Objective To investigate the safety of early whole body computed tomography(WBCT)combined with coronary angiography(CAG)in patients with extracorporeal cardiopulmonary resuscitation(ECPR)and its application value in the diagnosis of cardiac arrest and complications of cardiopulmonary resuscitation(CPR).Methods This was a retrospective study.Patients who underwent ECPR in the Emergency Department of the First Affi liated Hospital of Nanjing Medical University from January 2017 to July 2021 were enrolled in this research.Patients younger than 18 years or with incomplete clinical data were excluded.The results of WBCT and CAG examinations after ECPR were collected.Results A total of 89 patients with ECPR,aged 47±17 years,were enrolled in the study,all underwent WBCT examination,and no adverse events such as ECMO and tracheal tube shedding occurred.WBCT found 7 cases of pulmonary embolism,3 cases of aortic dissection and 2 cases of cerebral hemorrhage.WBCT identified CPR-related complications in 42 cases,including rib fractures(n=20),pneumothorax(n=5),mediastinal emphysema(n=5),subcutaneous emphysema(n=6),and hematoma or swelling at puncture site(n=6).Fifty-fi ve patients underwent CAG examination,the most common culprit vessels were the left anterior descending branch disease(58.2%)followed by the left circumfl ex branch disease(27.3%),the right coronary artery disease(21.8%)and left main artery disease(12.7%).Conclusions Early WBCT and CAG examinations are of great signifi cance and safety for the guidance of treatment in ECPR patients.

关 键 词：体外心肺复苏 全身计算机断层扫描 冠状动脉造影术 心肺复苏并发症 

分 类 号：R459.7[医药卫生—急诊医学]