复杂高危冠状动脉病变介入术中预防性使用IABP与VA-ECMO疗效具有一致性  

Consistency of effectiveness between prophylactic use of IABP and VA-ECMO in interventional treatment of complex high-risk coronary lesions

作　　者：宁志鸿 赵岳[1] 刘庆 欧韵 杨佳燕 唐惠芳[1] 胡恒境[1,2] NING Zhi-Hong;ZHAO Yue;LIU Qing;OU Yun;YANG Jia-yan;TANG Hui-fang;HU Heng-jing(Department of Cardiovascular Medicine,The First Affiliated Hospital of University of South China,Hunan Hengyang,421001,China;Institute of Cardiovascular Disease and Key Lab for Atherosclerosis of Hunan Province,University of South China,Hunan Hengyang,421001,China)

机构地区：[1]南华大学附属第一医院心血管内科,湖南衡阳421001 [2]南华大学心血管疾病研究所及湖南省动脉粥样硬化重点实验室,湖南衡阳421001

出　　处：《内科急危重症杂志》2024年第6期508-511,553,共5页Journal of Critical Care In Internal Medicine

基　　金：国家自然科学基金(81700306);湖南省自然科学基金(2022JJ30528);湖南省教育厅优秀青年基金(21B0408);湖南省卫生健康委重点指导课题(C202303019182);湖南省卫生健康委国家临床重点专科重大科研专项(Z2023006);2023年度湖南省社会科学成果评审委员会课题(XSP2023GLZ019)。

摘　　要：目的:比较复杂高危有介入治疗指征的冠心病患者(CHIP)术中行主动脉内球囊反搏(IABP)或静脉-动脉体外膜肺氧合(VA-ECMO)对死亡率、主要不良心脏事件(MACE)等临床结局的影响。方法:收集在IABP或VA-ECMO支持下(拒绝外科手术治疗或被外科拒绝)的24例CHIP进行单中心回顾性研究。根据治疗方式分为IABP组(18例)和VA-ECMO组(6例),评估2组在MACE、围术期死亡率、院内死亡率、30 d死亡率等方面的差异。结果:2组的基线特征均衡良好。2组患者的血流动力学不稳定发生率比较,差异无统计学意义(11.1%vs.16.7%,P=0.78);MACE的综合结局比较,差异无统计学意义(38.9%vs.33.3%,P=0.64)。IABP组的围术期死亡率为27.8%,VA-ECMO组为33.3%,两者比较差异无统计学意义(P=0.72)。两者院内死亡率与30d死亡率一致,IABP组为38.9%,VA-ECMO组为33.3%,两者比较差异无统计学意义(P=0.64)。VA-ECMO组平均住院时间更长(P=0.02)。结论:CHIP术中使用IABP或VA-ECMO装置作为机械循环支持在血流动力学不稳定性和总体MACE发生率方面无显著差异,选择IABP或VA-ECMO或许不会改变CHIP的远期生存结果。Objective:To compare the impact of intra-aortic balloon pump(IABP)and veno-arterial extracorporeal membrane oxygenation(VA-ECMO)on clinical outcomes,including mortality and major adverse cardiac events(MACE),in patients with complex high-risk coronary artery disease(CHIP)undergoing percutaneous coronary intervention.Methods:This single-center retrospective study included 24 CHIP patients who were either unsuitable for or declined surgical intervention and received mechanical circulatory support with either IABP or VA-ECMO.Patients were divided into an IABP group(18 cases)and a VA-ECMO group(6 cases).Clinical outcomes,including MACE,perioperative mortality,in-hospital mortality,and 30-day mortality,were compared between the two groups.Results:Baseline characteristics were well balanced between the two groups.There was no statistically significant difference in the incidence of hemodynamic instability between the two groups(11.1%vs.16.7%;P=0.78).The composite outcome of MACE showed no statistically significant difference between the groups(38.9%vs.33.3%;P=0.64).The perioperative mortality rate was 27.8%in the IABP group and 33.3%in the VA-ECMO group,and the difference was not statistically significant(P=0.72).The in-hospital mortality and 30-day mortality rates were consistent between the two groups,with 38.9%in the IABP group and 33.3%in the VA-ECMO group,and the difference was not statistically significant between the two groups(P=0.64).The mean length of hospital stay was longer in the VA-ECMO group(P=0.02).Conclusion:The use of IABP or VA-ECMO as mechanical circulatory support during CHIP procedures did not significantly differ in terms of hemodynamic stability or overall MACE outcomes.The choice between IABP and VA-ECMO may not significantly impact long-term survival outcomes in CHIP patients.

关 键 词：主动脉内球囊反搏 静脉-动脉体外膜肺氧合 复杂高危有介入治疗指征的冠心病患者 

分 类 号：R541.4[医药卫生—心血管疾病] R459.7[医药卫生—内科学]