体外膜肺氧合联合主动脉内球囊反搏在高危患者经皮冠状动脉介入治疗中的应用
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摘要
目的探讨体外膜肺氧合(ECMO)联合主动脉内球囊反搏(IABP)辅助支持对高危患者行经皮冠状动脉介入治疗(PCI)的作用及意义。方法纳入解放军总医院第六医学中心2012年5月至2015年11月在ECMO联合IABP辅助支持下对患者行PCI的7例患者。回顾分析7例患者的临床资料,包括基本情况、冠状动脉病变、手术过程、辅助时间、并发症及预后。结果患者平均年龄(74.86±12.56)岁,其中男性6例(6/7)。7例均经ECMO联合IABP辅助支持下行PCI成功,IABP平均辅助(7.14±2.55)d,ECMO平均辅助(70.00±18.48)min。术后ECMO、IABP顺利撤机,出现并发症2例(2/7)为(左侧腹股沟切口感染);7例患者中1例(1/7)死亡,6例(6/7)存活出院;在25.5(2.5,58.2)个月随访中,1例因支架内狭窄再次接受PCI,1例因败血症死亡,其余4例无主要不良心脑血管事件发生。结论采用ECMO联合IABP辅助支持下对高危患者行PCI是可行的。
Objective To explore the function and importance of Extracorporeal membrane oxygenation(ECMO) combined with Intra-aortic balloon pump(IABP) support for high-risk percutaneous coronary intervention(PCI). Methods We analyzed 7 cases undergoing high-risk PCI assisted by ECMO combined with IABP from May 2012 to November 2015 with close followed up. We retrospectively analyzed the clinical data of patients, including coronary artery lesions, operative process, duration of support,complications and prognosis. Results The average age was(74.86±12.56)years old including six male patients. PCI procedures were successful in all cases. The average time of using IABP and ECMO was(7.14±2.55) days and(70.00±18.48) minutes, respectively. All patients successfully weaned of f from ECMO and IABP. The complications occurred in 2 cases with the infection of the left groin incision. One patient died and six patients were survival to hospital discharged. During25.5(2.5,58.2)months follow-up, 1 patient received PCI again because of in-stent restenosis and 1 patient died from septicemia, the other 4 patients had no occurrence of cardiovascular or cerebrovascular diseases. Conclusions ECMO combined with IABPsupport for high-risk PCI is feasible.
Objective To explore the function and importance of Extracorporeal membrane oxygenation(ECMO) combined with Intra-aortic balloon pump(IABP) support for high-risk percutaneous coronary intervention(PCI). Methods We analyzed 7 cases undergoing high-risk PCI assisted by ECMO combined with IABP from May 2012 to November 2015 with close followed up. We retrospectively analyzed the clinical data of patients, including coronary artery lesions, operative process, duration of support,complications and prognosis. Results The average age was(74.86±12.56)years old including six male patients. PCI procedures were successful in all cases. The average time of using IABP and ECMO was(7.14±2.55) days and(70.00±18.48) minutes, respectively. All patients successfully weaned of f from ECMO and IABP. The complications occurred in 2 cases with the infection of the left groin incision. One patient died and six patients were survival to hospital discharged. During25.5(2.5,58.2)months follow-up, 1 patient received PCI again because of in-stent restenosis and 1 patient died from septicemia, the other 4 patients had no occurrence of cardiovascular or cerebrovascular diseases. Conclusions ECMO combined with IABPsupport for high-risk PCI is feasible.
引文
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[7]龙村.体外膜肺氧合循环支持专家共识.中国体外循环杂志,2014,12(2):65-69.
[8]刘迎午,李彤,王赟赟,等.体外膜肺氧合辅助下危重急性心肌梗死紧急介入治疗的临床疗效分析.中国介入心脏病学杂志,2015,23(12):689-692.
[9]Tomasello SD,Boukhris M,Ganyukov V,et al.Outcome of extracorporeal membrane oxygenation support for complex highrisk elective percutaneous coronary interventions:a single-center experience.Heart Lung,2015,44(4):309-313.
[10]Tsao NW,Shih CM,Yeh JS,et al.Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock.J Crit Care,2012,27(5):530.e1-e11.
[11]Di RGB,Martin GR.Extracorporeal membrane oxygenation for cardiac disease:no longer a mistaken diagnosis.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu,2005:34-40.
[12]段大为,李彤,张文芳,等.主动脉内球囊反搏与体外膜肺氧合联合用于急性心源性休克患者的抢救治疗.中国体外循环杂志,2010,8(1):29-31.
[13]Madershahian N,Wippermann J,Liakopoulos O,et al.The acute effect of IABP-induced pulsatility on coronary vascular resistance and graft fl ow in critical ill patients during ECMO.J Cardiovasc Surg(Torino),2011,52(3):411-418.
[14]李斌飞,廖小卒,程周,等.主动脉内球囊反搏联合体外膜肺氧合在爆发性心肌炎性心源性休克中的应用.中国体外循环杂志,2014,12(2):77-80.
[15]Gass A,Palaniswamy C,Aronow WS,et al.Peripheral venoarterial extracorporeal membrane oxygenation in combination with intra-aortic balloon counterpulsation in patients with cardiovascular compromise.Cardiology,2014,129(3):137-143.
[2]Rihal CS,Naidu SS,Givertz MM,et al.2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care:endorsed by the American Heart Assocation,the Cardiological Society of India,and Sociedad Latino Americana de Cardiologia Intervencion;Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention.J Am Coll Cardiol,2015,65(19):e7-e26.
[3]Cheng JM,den Uil CA,Hoeks SE,et al.Percutaneous left ventricular assist devices vs.intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock:a meta-analysis of controlled trials.Eur Heart J,2009,30(17):2102-2108.
[4]Perera D,Stables R,Thomas M,et al.Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention:a randomized controlled trial.JAMA,2010,304(8):867-874.
[5]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016).中华心血管病杂志,2016,44(5):382-400.
[6]汪蓉,唐炯,罗素新.成人体外膜肺氧合临床研究进展.心血管病学进展,2015,36(4):495-499.
[7]龙村.体外膜肺氧合循环支持专家共识.中国体外循环杂志,2014,12(2):65-69.
[8]刘迎午,李彤,王赟赟,等.体外膜肺氧合辅助下危重急性心肌梗死紧急介入治疗的临床疗效分析.中国介入心脏病学杂志,2015,23(12):689-692.
[9]Tomasello SD,Boukhris M,Ganyukov V,et al.Outcome of extracorporeal membrane oxygenation support for complex highrisk elective percutaneous coronary interventions:a single-center experience.Heart Lung,2015,44(4):309-313.
[10]Tsao NW,Shih CM,Yeh JS,et al.Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock.J Crit Care,2012,27(5):530.e1-e11.
[11]Di RGB,Martin GR.Extracorporeal membrane oxygenation for cardiac disease:no longer a mistaken diagnosis.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu,2005:34-40.
[12]段大为,李彤,张文芳,等.主动脉内球囊反搏与体外膜肺氧合联合用于急性心源性休克患者的抢救治疗.中国体外循环杂志,2010,8(1):29-31.
[13]Madershahian N,Wippermann J,Liakopoulos O,et al.The acute effect of IABP-induced pulsatility on coronary vascular resistance and graft fl ow in critical ill patients during ECMO.J Cardiovasc Surg(Torino),2011,52(3):411-418.
[14]李斌飞,廖小卒,程周,等.主动脉内球囊反搏联合体外膜肺氧合在爆发性心肌炎性心源性休克中的应用.中国体外循环杂志,2014,12(2):77-80.
[15]Gass A,Palaniswamy C,Aronow WS,et al.Peripheral venoarterial extracorporeal membrane oxygenation in combination with intra-aortic balloon counterpulsation in patients with cardiovascular compromise.Cardiology,2014,129(3):137-143.
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