早期VA-ECMO支持在急诊经皮冠脉介入治疗围手术期的应用价值  

The value of early VA-ECMO support in the perioperative period of emergency percutaneous coronary intervention

作　　者：余海佳 李静超[1] 宋慧慧[1] 崔路乾 董淑娟[3] 楚英杰[3] 秦历杰[1] Yu Haijia;Li Jingchao;Song Huihui;Cui Luqian;Dong Shujuan;Chu Yingjie;Qin Lijie(Emergency Department of Henan Provincial People's Hospital,Zhengzhou 450003,China;Coronary Care Unit,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Cardiology of Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院急诊科,郑州450003 [2]河南省人民医院CCU,郑州450003 [3]河南省人民医院心内科,郑州450003

出　　处：《中华急诊医学杂志》2024年第7期946-954,共9页Chinese Journal of Emergency Medicine

摘　　要：目的探讨急性心肌梗死合并心源性休克(acute myocardial infarction complicated by cardiogenic shock,AMICS)患者应用静脉-动脉体外膜肺氧合(venous-arterial extracorporeal membrane oxygenation,VA-ECMO)的不同时机对患者预后的影响。方法本研究为前瞻性队列研究,纳入2017年5月至2022年10月就诊于于河南省人民医院接受VA-ECMO支持经皮冠脉介入治疗(primary percutaneous coronary intervention,PPCI)的AMICS患者79例,根据VA-ECMO应用时机,分为早期VA-ECMO组和晚期VA-ECMO组;另纳入同期符合VA-ECMO适应症但未接受VA-ECMO支持的AMICS患者64例为对照组,收集3组患者的人口学基线特征、冠状动脉介入手术资料、围手术期并发症等指标。主要终点事件为1年内生存,次要终点事件为院内及围手术期死亡。采用多因素Logistic及Cox回归模型评估AMICS患者院内及1年内死亡的独立预测因素;采用Kaplan-Meier生存曲线分析3组患者1年内的生存结局。结果共纳入143例AMICS患者,最终136例患者资料纳入分析,其中早期VA-ECMO组42例,晚期VA-ECMO组34例,无VA-ECMO组60例。与晚期VA-ECMO组相比,早期VA-ECMO组患者VA-ECMO后PPCI的比例更高,入院门至导丝通过(door to balloon time,D-to-B)的时间更长、VA-ECMO的支持时间更短、撤机成功率更高,且并发症发生率较低(均P<0.05)。与早期VA-ECMO组相比,无VA-ECMO支持组围术期、院内及1年病死率均明显升高(均P<0.05)。早期VA-ECMO组与晚期VA-ECMO组围手术期及院内病死率差异虽无统计学意义,但晚期VA-ECMO组1年病死率明显较高(P<0.05);晚期VA-ECMO组和无VA-ECMO组相比,围手术期、院内及1年病死率虽降低,但差异均无统计学意义。多因素Logistic及Cox回归模型分析提示,校正干扰因素后,早期VA-ECMO仍是院内(OR=0.244,P=0.015)及1年(HR=0.308,P=0.001)死亡的保护因素;Kaplan-Merier生存曲线显示较晚期VA-ECMO及无VA-ECMO组,早期VA-ECMO组1年内生存率最高。结论与晚�Objective To investigate the effect of different timing of arterial-venous extracorporeal membrane oxygenation(VA-ECMO)on the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock(AMICS).Methods This study was a prospective cohort study.AMICS patients received VA-ECMO support primary percutaneous coronary intervention in Henan Provincial People's Hospital from May 2017 to July 2023 were divided into early VA-ECMO group and late VA-ECMO group.64 AMICS patients who met the indications for VA-ECMO implantation,but did not revive VA-ECMO were included as control group.Demographic characteristics,coronary interventional(PCI)information and complications after VA-ECMO implantation were collected.The primary end points was 1-year survival,minor end point were in-hospital and perioperative death.Multivariate Logistic and Cox regression models were used to evaluate the effect of timing of VA-ECMO on prognosis of AMICS patients.Kaplan-Meier survival curve was used to analyze the 1-year survival outcome of the 3 groups.Results A total of 143 AMICS patients were included,and materials of 136 patients entered in the final analysis,including 42 in the early VA-ECMO group,34 in the late VA-ECMO group,and 60 in the non-VA-ECMO group.Compared with the late VA-ECMO group,the early VAECMO group had a higher ratio of PPCI after VA-ECMO,a longer D-to-B time,a shorter VA-ECMO support time,a higher success rate of VA-ECMO withdrawal,and a lower complication rate(all P<0.05).Compared with the early VA-ECMO group,the perioperative,in-hospital and 1-year mortality were significantly higher in Non-ECMO support(all P<0.05).There was no difference in perioperative and in-hospital mortality between the early VA-ECMO group and the late VA-ECMO group,but the 1-year mortality in the late VA-ECMO group was significantly higher(P<0.05).Perioperative,in-hospital and 1-year mortality rates were lower in the late VA-ECMO group than in the no-VA-ECMO group,but the differences were not statistically significant.Multi

关 键 词：急性心肌梗死 心源性休克 静脉-动脉体外膜肺氧合 经皮冠状动脉介入 

分 类 号：R654.2[医药卫生—外科学]