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广东中山市人民医院使用ECMO救治心梗心脏骤停经验:联合PCI救治成功率近50%

2018-07-13 朱柳媛 中国循环杂志

急性心肌梗死后出现心脏骤停,往往需要先进行心肺复苏后,再行冠脉介入治疗。而急救药物及主动脉内球囊反搏(IABP)等传统的机械循环辅助手段,往往无法维持患者稳定的循环功能,血流动力学不稳定状态可持续恶化,使患者错过行急诊冠脉介入治疗的最佳时机,预后不佳。

急性心肌梗死后出现心脏骤停,往往需要先进行心肺复苏后,再行冠脉介入治疗。而急救药物及主动脉内球囊反搏(IABP)等传统的机械循环辅助手段,往往无法维持患者稳定的循环功能,血流动力学不稳定状态可持续恶化,使患者错过行急诊冠脉介入治疗的最佳时机,预后不佳。

广东中山市人民医院心血管内科吴颖等发文报告,他们利用体外膜肺氧合(ECMO)这种新型的体外呼吸循环辅助装置,联合急诊冠脉介入治疗,救治急性心梗后心脏骤停患者,存活率较高,达45.9%。

经多因素非条件Logistic回归分析,研究者发现,罪犯血管为左前降支、多支血管病变、心肺复苏时间较长、心脏骤停后ECMO植入较晚等因素会增加患者的死亡风险,而植入ECMO复苏后48小时平均动脉压较高的患者死亡风险较低。

研究者回顾性分析2015-01至2017-01期间植入ECMO、并接受急诊冠脉介入治疗的37例急性心梗后心脏骤停患者,其中男性28例(75.7%),17例存活。

所有患者植入ECMO复苏成功、恢复自主心跳、血流动力学稳定后,接受急诊冠脉介入治疗,手术成功率100%。

作者强调,植入ECMO抢救需注意以下几点:

(1)ECMO的建立必须迅速。研究显示心脏骤停至植入ECMO时间是影响患者存活的重要因素。

(2)植入ECMO过程中必须持续传统的心肺复苏。

(3)植入ECMO抢救过程中要注意控制血压及血管活性药物的使用剂量及给药速度。

(4)在评估患者恢复情况下要实施撤离,可降低严重并发症的发生率。该研究37例患者中1例患者出现较为严重的下肢缺血性损害,考虑原因可能与撤机前肝素用量不足,撤机过程使用取栓器损伤血管内皮有关。

原始出处:
吴颖,张励庭,冯力,等. 体外膜肺氧合联合急诊经皮冠状动脉介入治疗抢救急性心肌梗死后心脏骤停患者的临床疗效及其影响因素分析. 中国循环杂志, 2018, 33:561-566.

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    2019-03-21 zhangbaojun
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    2018-09-03 liubm564
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    2018-07-15 张新亮1853311252142e2fm

    好文献学习了

    0

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    2018-07-13 131****1460

    学习了受益匪浅

    0

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    2018-07-13 三生有幸9135

    学习一下

    0

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    2018-07-13 zb1235672

    学习了!!!!!

    0

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