主动脉内球囊反搏支持下直升机转运急性心肌梗死合并心源性休克案例分析  

Helicopter transport of acute myocardial infarction with cardiogenic shock supported by intra-aortic balloon counterpulsation

作　　者：张治平 叶其圣 苏晞 张勇[1] 吴明祥 任海波 袁观惺 ZHANG Zhiping;YE Qisheng;SU Xi;ZHANG Yong;WU Mingxiang;REN Haibo;YUAN Guanxing(Wuhan Asia General Hospital affiliated of Wuhan University of Science and Technology,Wuhan Hubei 430037,China)

机构地区：[1]武汉科技大学附属武汉亚心总医院,湖北武汉430037 [2]武汉科技大学医学院,湖北武汉430065

出　　处：《中国急救复苏与灾害医学杂志》2023年第11期1427-1431,1468,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：武汉市卫生健康科研基金(编号:WG20D13)。

摘　　要：目的 总结主动脉内球囊反搏(IABP)支持下直升机航空医疗救护转运急性心肌梗死合并心源性休克患者的临床经验与体会。方法 收集2021年12月—2022年9月武汉亚心总医院主动脉内球囊反搏支持下直升机转运急性心肌梗死患者的临床资料,包括性别、年龄、诊断、IABP辅助原因、转运途中病情变化、不良事件、主要治疗措施、住院转归等;同时收集飞行任务数据,包括转运距离、任务确定时间、航线审批时间、起飞时间、派遣飞行时间、地面接驳时间、转运时间等。结果 IABP支持下转运急性心肌梗死合并心源性休克共6例,其中,急性广泛前壁和/或前壁心肌梗死3例,急性下壁和/或右室心肌梗死3例;合并三度房室传导阻滞与尖端扭转性室性心动过速1例,院内心脏骤停2例。转运途中最主要的病情变化是低氧、血压下降以及心律失常。发生一起因温度过高IABP自动断电不良事件,未发生死亡和其他严重并发症事件。转运单程距离为192.7±69.8(90~310)km;任务确定至起飞时间为36.8±10.8(22~54)min;派遣飞行时间为56.0±21.0(26~91)min;转运时间为57.3±27.0(26~108)min;任务总时间为215.7±48.9(175~307)min。结论 IABP支持下的急危重症患者直升机转运是救治关口整体前移的具体应用与实践,IABP循环辅助与航空医疗救护相结合的转运方式,保证了患者的医疗安全,使心脏危重症患者得到有效的救治。Objective To summarize the clinical experience of helicopter air medical transport of patients with acute myocardial infarction complicated with cardiogenic shock supported by intra-aortic balloon counterpulsation(IABP).Methods From December 2021 to September 2022,the clinical data of patients with acute myocardial infarction transported by helicopter under the support of IABP in Wuhan Asia General Hospital were collected,including gender,age,diagnosis,reasons for IABP support,patient's condition during transportation,adverse events,main treatment measures,and hospital outcomes.The flight mission data,including transfer distance,mission determination time,route approval time,departure time,dispatch flight time,ground connection time,transfer time,etc were also collected.Results There were 6 cases of acute myocardial infarction with cardiogenic shock supported by IABP,including 3 cases of acute extensive anterior wall and/or anterior wall myocardial infarction,and 3 cases of acute inferior wall and/or right ventricular myocardial infarction;one patient had third degree atrioventricular block with torsade de pointes ventricular tachycardia,and two patients had cardiac arrest.The most important changes during transport were hypoxemia,decreased blood pressure,and arrhythmia.An adverse event of IABP automatic power failure due to excessive temperature occurred,and no death or other serious complications occurred.One way distance of transportation was 192.7±69.8(90-310)km;the time from task determination to take off was 36.8±10.8(22-54)min;dispatch flight time was 56.0±21.0(26-91)min;transfer time was 57.3±27.0(26-108)min;the total task time was 215.7±48.9(175-307)min.Conclusion The helicopter transfer of critical patients supported by IABP is a specific application and practice of moving forward the whole rescue gateway.The combination of IABP circulatory assistance and air medical transport ensures the medical safety of patients and enables effective treatment of critically ill patients with heart disease.

关 键 词：主动脉内球囊反搏 直升机 航空医疗转运 急性心肌梗死 心源性休克 

分 类 号：R459.7[医药卫生—急诊医学]