山区医院体外心肺复苏救治3例心搏骤停患者的体会并文献复习  

Experience and literature review on extracorporeal cardiopulmonary resuscitation in 3 patients with cardiac arrest in a mountain area hospital

作　　者：汤湖波 吴先智 张晶鑫 邹勇 李作威 陈然 周维微 杨波 左小淑 魏捷[5] 陈静[5] Tang Hubo;Wu Xianzhi;Zhang Jingxin;Zou Yong;Li Zuowei;Chen Ran;Zhou Weiwei;Yang Bo;Zuo Xiaoshu;Wei Jie;Chen Jing(Department of Critical Care Medicine,People's Hospital of Wufeng Tujia Autonomous County,Yichang 443413,Hubei,China;Department of Emergency,People's Hospital of Wufeng Tujia Autonomous County,Yichang 443413,Hubei,China;Department of Cardiology,People's Hospital of Wufeng Tujia Autonomous County,Yichang 443413,Hubei,China;Department of Critical Care Medicine,People's Hospital of Wuhan University,Wuhan 430060,Hubei,China;Department of Emergency,People's Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]五峰土家族自治县人民医院重症医学科,湖北宜昌443413 [2]五峰土家族自治县人民医院急诊科,湖北宜昌443413 [3]五峰土家族自治县人民医院心内科,湖北宜昌443413 [4]武汉大学人民医院重症医学科,湖北武汉430060 [5]武汉大学人民医院急诊科,湖北武汉430060

出　　处：《中国中西医结合急救杂志》2024年第6期735-738,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：中央高校基本科研项目(2042022kf106);湖北省省级临床重点专科建设项目(2023-25)。

摘　　要：目的分析成人体外心肺复苏(ECPR)抢救山区医院3例心源性心搏骤停患者的诊治效果,为临床诊疗提供参考。方法回顾性分析五峰土家族自治县人民医院2023年1月至12月收治的3例心源性心搏骤停患者的联合救治过程,并总结治疗经验。结果3例患者均在进行持续心肺复苏、电除颤等治疗措施的同时,紧急启动了ECPR联合救治流程。首先,在超声引导下采用中心静脉导管(CVC)预先建立体外膜肺氧合(ECMO)血管通路,等上级医院ECMO设备到达后进行管路置换,大大节约了后续救治时间。最终2例急性心肌梗死患者在ECMO保障下均急诊行冠状动脉(冠脉)造影和经皮冠脉介入术(PCI)后,自主心律恢复,生命体征逐步稳定,其中1例患者转上级医院治疗后痊愈出院,另1例在血流动力学稳定后行康复治疗;第3例肥厚型心肌病心搏骤停患者行ECMO后自主心律恢复,转上级医院后因神经功能恢复差,家属选择放弃治疗。结论ECPR是对传统心肺复苏治疗无法恢复自主心律或对反复心搏骤停无法维持自主心律患者实施的快速ECMO辅助心肺复苏,以提升患者生存率。在基层医疗中心无相应条件时,能早期寻求区域高级医疗中心帮助,使患者在ECMO支持下快速转运及手术,为患者良好预后提供保障。Objective To analyze the treatment effects of extracorporeal cardiopulmonary resuscitation(ECPR)in 3 patients with cardiac arrest due to cardiac causes in a mountain area hospital,providing a reference for clinical diagnosis and treatment.Methods The combined treatment process of 3 patients with cardiogenic cardiac arrest admitted to Wufeng Tujia Autonomous County People's Hospital from January to December 2023 was retrospectively analyzed,and the treatment experience was summarized.Results All 3 patients underwent continuous cardiopulmonary resuscitation and defibrillation while urgently initiating the ECPR combined rescue process.First,a central venous catheter(CVC)was established under ultrasound guidance to create access for extracorporeal membrane oxygenation(ECMO).Once the ECMO equipment from a higher-level hospital arrived,the circuit was replaced,significantly reducing the time required for subsequent patient treatment.Finally,two patients with acute myocardial infarction underwent emergency coronary angiography and percutaneous coronary intervention(PCI)under ECMO support,resulting in the restoration of spontaneous cardiac rhythm and gradual stabilization of vital signs.The last patient was discharged after recovery following transfer to a higher-level hospital,while another patient received rehabilitation treatment after hemodynamic stability was achieved.The third patient,who experienced cardiac arrest due to hypertrophic cardiomyopathy,regained spontaneous rhythm after ECMO,but due to poor neurological recovery after transfer to a higher-level hospital,the family chose to withdraw treatment.Conclusions ECPR is a rapid extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation method for patients who cannot regain spontaneous rhythm or experience recurrent cardiac arrest.It aims to improve patient survival rates.In grassroots medical centers lacking the necessary conditions,early assistance from regional advanced medical centers can ensure rapid transfer and surgery under ECMO support,p

关 键 词：心肌梗死 肥厚型心肌病 心源性休克 体外膜肺氧合辅助心肺复苏 经皮冠脉介入术 

分 类 号：R47[医药卫生—护理学]