机械辅助循环在心肌梗死后室间隔穿孔治疗中的临床应用进展  

Progress on the clinical application of mechanical circulatory support in the treatment of post-infarct ventricular septal rupture

作　　者：王炳然 张岩[1] WANG Bing-ran;ZHANG Yan(Department of Cardiac Surgery,Fu wai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心脏外科,北京市100037

出　　处：《中国心血管病研究》2024年第7期658-664,共7页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金面上项目(82172099)。

摘　　要：心肌梗死后室间隔穿孔(post-infarct ventricular septal rupture,PIVSR)是心肌梗死的严重并发症,常表现为心源性休克,即使提供及时干预,患者院内病死率仍极高。目前指南建议对所有患者立即进行手术,但理想的干预时机仍存在争议。近年来,包括IABP、体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)、Impella和TandemHeart等在内的现代机械循环支持(mechanical circulatory support,MCS)技术发展迅速,为患者提供稳定血流动力学支持的同时使延迟手术治疗成为可能,其可能成为PIVSR患者成功救治的新希望。然而,相关临床证据的缺乏一定程度上限制了MCS的进一步推广,不同MCS策略的比较和选择也成为PIVSR患者救治过程中丞待解决的关键性问题,基于这些疑问本文就PIVSR患者中MCS的辅助治疗作一综述。Post-infarct ventricular septal rupture(PIVSR)is a severe complication of myocardial infarction.It often manifests as cardiogenic shock,and even with timely intervention,the hospital mortality rate remains extremely high.Currently,the guidelines recommend immediate surgery for all the patients,but there is still controversy over the ideal timing of intervention.In recent years,modern mechanical circulatory support(MCS)technologies,including intra-aortic balloon pump(IABP),extracorporeal membrane oxygenation(ECMO),Impella and TandemHeart,have developed rapidly,providing stable hemodynamics for the patients while making delayed surgical treatment possible,which may become a new hope for the successful treatment of PIVSR patients.However,the lack of relevant clinical evidence has limited the further promotion of MCS to some extent,and the comparison and selection of different MCS strategies have become a key issue in the treatment process of PIVSR patients.Based on these questions,this article provides a review of the adjuvant therapy of MCS in PIVSR patients.

关 键 词：急性心肌梗死 心肌梗死后室间隔穿孔 机械循环支持 体外膜肺氧合 

分 类 号：R542.22[医药卫生—心血管疾病]