体外膜肺氧合辅助治疗高危复杂冠心病患者行PCI的临床效果  

Clinical outcomes of extracorporeal membrane oxygenation in complex high-risk and indicated patients undergoing PCI

作　　者：胡聪龙 尹礼义 黄明君[2] 曹彦[1] 韩小彤[1] Hu Conglong;Yin Liyi;Huang Mingjun;Cao Yan;Han Xiaotong(Department of Emergency,Hunan Provincial People′s Hospital(the First Affiliated Hospital of Hunan Normal University),Clinical Research Center For Emergency and Critical Care in Hunan Province,Hunan Provincial Institute of Emergency Medicine,Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics,Changsha 410000,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科,湖南省急危重症临床医学研究中心,湖南省急救医学研究所,急危重症代谢组学湖南省重点实验室,湖南长沙410000 [2]郑州大学第一附属医院体外支持中心,河南郑州410021

出　　处：《中国急救医学》2024年第11期943-947,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金面上项目(82372178);湖南省急危重症临床医学研究中心(2021SK4011)。

摘　　要：目的评估体外膜肺氧合(ECMO)辅助治疗接受经皮冠状动脉介入(PCI)的高危复杂冠心病患者(complex high-risk and indicated patients,CHIPs)的临床效果。方法回顾性分析52例CHIPs并接受PCI治疗的患者,按ECMO辅助时机分为术前辅助组(n=24)和术中辅助组(n=28)。对比两组患者基线资料、术前状态、院内病死率、冠状动脉造影结果、冠状动脉评分及并发症发生率。结果术前辅助组院内病死率显著低于术中辅助组(12.5%vs.64.3%,P<0.001)。术前辅助组中有5例(20.8%)联合使用主动脉内球囊反搏(intra-aortic balloon pump,IABP),而术中辅助组则为14例(50%)。两组白细胞计数、高密度脂蛋白水平、术中最差乳酸值及总病死率差异有统计学意义(均P<0.05),术前辅助组表现更佳。术前辅助组神经系统、心脏及四肢并发症的发生率也显著低于术中辅助组(均P<0.05),但冠脉评分、冠状动脉造影结果、冠脉血管病变程度、体外膜肺氧合上机操作时间、辅助时间及PCI手术时间等差异无统计学意义(均P>0.05)。结论ECMO辅助CHIPs患者PCI治疗时,术前应用更能有效降低病死率及ECMO相关并发症的发生率,可为CHIPs患者的治疗提供一种更为优化的策略。Objective To evaluate the clinical outcomes of extracorporeal membrane oxygenation(ECMO)support in complex high-risk and indicated patients(CHIPs)undergoing percutaneous coronary intervention(PCI).Methods A retrospective analysis was conducted on 52 CHIPs who underwent PCI.Patients were divided into two groups based on the timing of ECMO support:a preoperative support group(n=24)and an intraoperative support group(n=28).Baseline characteristics,preoperative conditions,in-hospital mortality rate,coronary angiography results,coronary scores and the incidence of complications were compared between the two groups.Results The in-hospital mortality rate in the preoperative support group was 12.5%,which was significantly lower than the 64.3%in the intraoperative support group(P<0.001).In the preoperative support group,5 patients(20.8%)accepted concomitant intra-aortic balloon pump(IABP)compared to 14 patients(50%)in the intraoperative group.Statistically significant differences were found in terms of leukocyte count,high-density lipoprotein levels,intraoperative lactate peak,and overall mortality rate between the two groups(all P<0.05),and the preoperative support group demonstrated better outcomes.Furthermore,the incidence of neurological,cardiac,and limb complications was significantly lower in the preoperative support group(all P<0.05).However,there were no statistical differences in coronary scores,coronary angiography results,extent of coronary lesions,ECMO setup time,duration of ECMO support and PCI procedure time between the two groups(all P>0.05).Conclusions For CHIPs undergoing PCI,preoperative ECMO support effectively reduces the mortality rate and ECMO-related complications.This strategy provides an optimized treatment approach for CHIPs.

关 键 词：体外膜肺氧合 复杂高危冠心病 经皮冠状动脉介入治疗 临床效果 主动脉内球囊反搏 并发症 

分 类 号：R541.4[医药卫生—心血管疾病]