静脉-动脉体外膜氧合在经皮冠状动脉介入治疗围术期应用时机的比较  

Comparison of veno-arterial extracorporeal membrane oxygenation timing in the perioperative period of percutaneous coronary intervention

作　　者：王靖[1] 卞璐瑜[1] 李真真[1] 刘刚[1] 王建[1] 王茜[1] 滕媛 王添隆 张寒[1] 闫姝洁 楼松[1] 胡强[1] 高国栋[1] 吉冰洋[1] Wang Jing;Bian Luyu;Li Zhenzhen;Liu Gang;Wang Jian;Wang Qian;Teng Yuan;Wang Tianlong;Zhang Han;Yan Shujie;Lou Song;Hu Qiang;Gao Guodong;Ji Bingyang(Department of Cardiopulmonary Bypass,Fuwai Hospital,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,阜外医院体外循环中心,北京100037

出　　处：《中国体外循环杂志》2024年第5期365-370,399,共7页Chinese Journal of Extracorporeal Circulation

基　　金：中国医学科学院临床与转化医学研究基金(2020-I2M-C&T-B-054)。

摘　　要：目的 评估经皮冠状动脉介入(PCI)治疗围术期应用体外膜氧合(ECMO)支持的时机对心肌梗死患者的疗效和安全性。方法 回顾性分析2018年1月至2022年8月在中国医学科学院阜外医院接受PCI治疗并应用ECMO支持的患者资料,共计14例患者。根据ECMO启动时机分为预置ECMO支持组(6例)和非预置ECMO支持组(8例)。收集患者的临床资料、PCI治疗情况、机械支持情况、并发症及结局。结果 14例患者平均年龄为(57.9±13.3)岁,男性占12例(85.7%)。预置ECMO支持组主要为三支病变(66.7%),非预置ECMO支持组主要为单支及双支病变(75%)。预置ECMO支持组置入支架中位数和置入球囊中位数均显著高于非预置ECMO支持组(3 vs. 1,P=0.005;6 vs. 2,P=0.020)。预置ECMO支持组PCI中位时间大于非预置ECMO支持组(109 min vs. 27 min,P=0.042)。非预置ECMO支持组死亡率显著高于预置ECMO支持组(75.0%vs. 16.7%,P=0.031),两组患者在相关并发症上无显著差异。结论 预防性应用ECMO支持提高了心肌梗死患者PCI治疗的血运重建率及生存率,且并未增加并发症的发生风险。Objective To assess the efficacy and safety of extracorporeal membrane oxygenation(ECMO)support timing during the perioperative period of percutaneous coronary intervention(PCI)in patients with myocardial infarction.Methods A retrospective analysis of patients who underwent PCI and received ECMO support at Fuwai Hospital from January 2018 to August 2022 was conducted,involving a total of 14 patients.Patients were divided into two groups based on the timing of ECMO initiation:the prophylactic ECMO support group(n=6)and the non-prophylactic ECMO support group(n=8).Clinical data,PCI treatment details,mechanical support,complications,and outcomes were collected.Results The mean age of the 14 patients was(57.9±13.3)years,with males accounting for 85.7%.The prophylactic ECMO support group mainly had triple vessel disease(66.7%),while the non-prophylactic ECMO support group mainly had single or double vessel disease(75%).The median number of stents and balloons inserted in the prophylactic ECMO support group was significantly higher than that in the non-prophylactic ECMO support group(3 vs.1,P=0.005,6 vs.2,P=0.020;respectively).The median duration of PCI was longer in the prophylactic ECMO support group compared to the non-prophylactic ECMO support group(109 min vs.27 min,P=0.042).The mortality rate was significantly higher in the prophylactic ECMO support group compared to the non-prophylactic ECMO support group(75.0%vs.16.7%,P=0.031),with no significant difference in complications between the two groups.Conclusion Prophylactic ECMO support improves the revascularization rate and survival rate of myocardial infarction patients undergoing PCI,without increasing the risk of complications.

关 键 词：心肌梗死 体外膜氧合 经皮冠状动脉介入 心原性休克 心脏骤停 

分 类 号：R541.4[医药卫生—心血管疾病]