体外膜肺氧合在急性心肌梗死介入治疗围手术期中的应用

doi:10.3969/j.issn.1002-1949.2019.04.017

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摘要目的探讨体外膜肺氧合(ECMO)在急性心肌梗死经皮冠状动脉介入治疗（PCI）围手术期中的临床应用效果。方法纳入2016年7月1日至2018年7月1日在南方医科大学顺德医院接受PCI治疗的围手术期因血流动力学不稳定需要ECMO支持的高危型急性心肌梗死患者。收集死亡组、生存组的临床资料并进行比较,分析影响患者预后的危险因素。结果共纳入14例患者，生存组6例，死亡组8例，生存出院率为6/14。ECMO适应证：难治性心源性休克11例，难治性心脏骤停2例，顽固性恶性心律失常1例。ECMO支持时机：12例患者在PCI后建立ECMO，2例先建立ECMO再行PCI。两组男性比例、年龄、APACHEⅡ评分及ECMO支持前肌钙蛋白、肌酸激酶同工酶（CK-MB）、脑钠肽（BNP）、左室射血分数（LVEF）差异无统计学意义(P均＞0.05)。死亡组ECMO支持前乳酸水平明显高于生存组（mmol/L：12.2±5.2vs. 6.2±2.2，t=-2.614, P=0.023）。两组PCI成功例数分别为6例、7例，两组在PCI后TIMI分级、主动脉内球囊反搏支持例数、因并发心源性休克至建立ECMO的时间、ECMO辅助时间、ICU住院时间差异无统计学意义(P均＞0.05)。死亡原因：3例为多器官衰竭，2例撤ECMO后难治性心衰,2例感染性休克,1例缺血缺氧性脑病。结论 ECMO能为高危型急性心肌梗死PCI的围手术期提供重要循环支持，而准确把握支持时机，减少相关并发症有助于提高生存出院率，监测ECMO支持前乳酸水平有助于评估预后。

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	刘长智
	周柱江
	卢剑海
	左六二

关键词 ：体外膜肺氧合(ECMO), 急性心肌梗死, 经皮冠状动脉介入治疗

作者简介: 刘长智（1986-），男，硕士，主治医师，E-mail: lcz1986316@163.com。

引用本文:

刘长智，周柱江，卢剑海，左六二. 体外膜肺氧合在急性心肌梗死介入治疗围手术期中的应用[J]. 中国急救医学, 2019, 39(4): 377-381.
Liu Chang-zhi, Zhou Zhu-jiang, Lu Jian-hai, Zuo Liu-er. Extracorporeal membranous oxygenation support for acute myocardial infarction patients in the periprocedural period of percutaneous coronary intervention. Chinese Journal of Critical Care Medicine, 2019, 39(4): 377-381.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.04.017 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I4/377

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