经皮穿刺插管建立体外膜肺氧合应用于高危经皮冠状动脉介入治疗患者的安全性和有效性  

Safety and efficacy of percutaneous cannulation for extracorporeal membrane oxygenation in high-risk patients undergoing percutaneous coronary intervention

作　　者：徐俊杰 徐承义 刘成伟 宋丹 鄢华 马小静 XU Jun-jie;XU Cheng-yi;LIU Cheng-wei;SONG Dan;YAN Hua;MA Xiao-jing(Department of Cardiology,Wuhan Asia Heart Hospital Affiliated to Wuhan University Science and Technology,Wuhan 430022,China;Medical College of Wuhan University of Science and Technology,Wuhan 430062,China)

机构地区：[1]武汉科技大学附属武汉亚洲心脏病医院心内科,湖北武汉430022 [2]武汉科技大学医学部医学院,湖北武汉430062

出　　处：《中国介入心脏病学杂志》2025年第3期128-134,共7页Chinese Journal of Interventional Cardiology

基　　金：湖北省武汉市科技局项目(2019020701011422);武汉市心血管影像临床医学研究中心2023年度开放基金立项项目(CMRC202305)。

摘　　要：目的探讨经皮穿刺建立静脉-动脉体外膜肺氧合(VA-ECMO)路径的安全性和VA-ECMO辅助下行高危经皮冠状动脉介入治疗(HR-PCI)的有效性。方法本研究为单中心、回顾性研究,纳入2022年12月至2023年12月在武汉亚洲心脏病医院接受VA-ECMO辅助下行HRPCI的患者,研究主要终点是经皮穿刺建立VA-ECMO路径的安全性,特征主要是体外膜肺氧合(ECMO)相关并发症,包括伤口严重出血/血肿、动静脉瘘、假性动脉瘤、外周动脉夹层及死亡等。次要终点是VA-ECMO辅助下行HR-PCI的有效性,定义为6个月随访时主要不良心脑血管事件(MACCE),包括全因死亡、非致死性心肌梗死、非计划再次血运重建、缺血性脑卒中的复合事件。结果研究纳入189例患者,VA-ECMO导致的穿刺伤口严重出血/血肿15例(7.9%),伤口感染8例(4.2%),动静脉瘘1例(0.5%),假性动脉瘤4例(2.1%),外周动脉夹层3例(1.6%),体循环栓塞/血栓形成8例(4.2%),急性肾损伤8例(4.2%),急性神经系统损伤3例(1.6%),死亡1例(0.5%)。经皮冠状动脉介入治疗(PCI)成功182例(96.3%),PCI相关并发症共36例(19.0%)。164例患者完成6个月随访,其中全因死亡4例(2.4%),非致死性心肌梗死11例(6.7%),非计划再次血运重建11例(6.7%),缺血性脑卒中的复合事件2例(1.2%)。结论超声引导下经皮穿刺建立VA-ECMO路径具有较高的安全性,VA-ECMO辅助下行HR-PCI在患者中具有良好的短期效果。Objective To explore the safety of establishing the veno-arterial extracorporeal membrane oxygenation(VA-ECMO) pipeline through percutaneous puncture and the effectiveness of high-risk percutaneous coronary intervention(HR-PCI) under VA-ECMO assistance.Methods In this single-center retrospective study,patients who underwent HR-PCI assisted by VA-ECMO at Wuhan Asian Heart Hospital from December 2022 to December 2023 were included.The primary endpoint was the safety of establishing the VA-ECMO pipeline through percutaneous puncture,mainly characterized by extracorporeal membrane oxygenation(ECMO)-related complications,including severe bleeding/hematoma at the wound,arteriovenous fistula,pseudoaneurysm,peripheral arterial dissection,etc.The secondary endpoint was the effectiveness of HR-PCI under VA-ECMO assistance,defined as major adverse cardiovascular and cerebrovascular events(MACCE) at 6-month follow-up,including the composite events of all-cause death,non-fatal myocardial infarction,repeat revascularization,and ischemic stroke.Results Among the 189 patients included in the study,15(7.9%) had severe bleeding/hematoma at the puncture wound caused by VA-ECMO,8(4.2%) had wound infection,1(0.5%)had arteriovenous fistula,4(2.1%) had pseudoaneurysm,3(1.6%) had peripheral arterial dissection,8(4.2%) had systemic embolism,8(4.2%) had acute kidney injury,3(1.6%) had acute neurological injury,and 1(0.5%) died.percutaneous coronary intervention(PCI) was successful in 182 cases(96.3%),and a total of 36 cases(19.0%) had PCI-related complications.164 patients completed 6-month follow-up,among which 4(2.4%) had all-cause death,11(6.7%) had non-fatal myocardial infarction,11(6.7%) had unplanned repeat revascularization,and 2(1.2%) had the composite event of ischemic stroke.Conclusions Ultrasound-guided percutaneous puncture for establishing the VA-ECMO pipeline has high safety,and HR-PCI patients assisted by VA-ECMO have good short-term effects.

关 键 词：高危经皮冠状动脉介入治疗 静脉-动脉体外膜肺氧合 机械循环支持 并发症 

分 类 号：R54[医药卫生—心血管疾病]