主动脉内球囊反博术联合体外膜肺氧合在成人暴发性心肌炎并发心源性休克中的应用
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摘要
目的探讨主动脉内球囊反博术(intra-aortic balloon pump,IABP)联合体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗成人暴发性心肌炎(fulminant myocarditis,FM)并发心源性休克(cardiogenic shock,CS)患者的临床经验。方法对2015年2月至2017年9月中国医学科学院阜外医院深圳医院心内科重症监护室6例成人FM并发CS患者,在大剂量的血管活性药物以及IABP辅助下,血流动力学仍呈恶化趋势,而应用静脉-动脉模式ECMO支持,回顾性分析其住院期间及出院随访资料。结果患者年龄(29.50±5.54)岁,其中男1例(16.7%),女5例(83.3%)。ECMO支持时间(154.67±56.40)h,IABP支持时间(179.00±62.92)h。在6例患者中,5例(83.3%)患者成功脱离ECMO辅助循环并顺利出院,出院后随访至今,患者的心功能正常。1例患者未能撤机,死于并发症。结论在药物及时治疗和积极防治并发症的基础上,IABP联合ECMO辅助循环治疗可能在FM并发CS患者中起协同作用,改善患者预后。
ObjectivesTo investigate the clinical effect of combining extra-corporeal membrane oxygenation(ECMO)with intra-aortic balloon pump(IABP)for the treatment of fulminant myocarditis(FM)complicated by cardiogenic shock(CS)in adult.MethodsThe clinical data of 6 patients who received ECMO combined with IABP due to FM complicated by CS between February 2015 and September 2017 in Fuwai Hospital Chinese Academy of Medical Science,Shenzhen,were retrospectively analyzed.ResultsThe median age was(29.50±5.54)years old with 1 man and 5 women. Among the 6 patients,the median duration of using ECMO was(154.67±56.40)hours. The median duration of using IABP was(179.00±62.92) hours. Five(83.3%) patients successfully weaned from ECMO and survived to discharged. Follow-up to date,the cardiac functions of the patients were normal. The one patient who did not survive due to complications.ConclusionsIABP combined with ECMO may has synergistic effects and play complementary roles in the treatment of FM complicated by CS in adult;with timely administration,active prevention and treatment of complications,they can improve treatment outcome.
ObjectivesTo investigate the clinical effect of combining extra-corporeal membrane oxygenation(ECMO)with intra-aortic balloon pump(IABP)for the treatment of fulminant myocarditis(FM)complicated by cardiogenic shock(CS)in adult.MethodsThe clinical data of 6 patients who received ECMO combined with IABP due to FM complicated by CS between February 2015 and September 2017 in Fuwai Hospital Chinese Academy of Medical Science,Shenzhen,were retrospectively analyzed.ResultsThe median age was(29.50±5.54)years old with 1 man and 5 women. Among the 6 patients,the median duration of using ECMO was(154.67±56.40)hours. The median duration of using IABP was(179.00±62.92) hours. Five(83.3%) patients successfully weaned from ECMO and survived to discharged. Follow-up to date,the cardiac functions of the patients were normal. The one patient who did not survive due to complications.ConclusionsIABP combined with ECMO may has synergistic effects and play complementary roles in the treatment of FM complicated by CS in adult;with timely administration,active prevention and treatment of complications,they can improve treatment outcome.
引文
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[6]中华医学会心血管病学分会精准医学学组,中华心血管病杂志编辑委员会,成人暴发性心肌炎工作组.成人暴发性心肌炎诊断与治疗中国专家共识[J].内科急危重症杂志,2017,23(6):443-453.
[7]MASON J W,O’CONNELL J B,HERSKOWITZ A,et al.Aclinical trial of immunosuppressive therapy for myocarditis.Themyocarditis treatment trial investigators[J].N Engl J Med,1995,333(5):269-275.
[8]GINSBERG F,PARRILLO J E.Fulminant myocarditis[J].Crit Care Clin,2013,29(3):465-483.
[9]MCCARTHY R E,BOEHMER J P,HRUBAN R H,et al.Long-term outcomeof fulminant myocarditis as compared with acute(nonfulminant)myocarditis[J].N Engl J Med,2000,342(10):690-695.
[10]IHDAYHID A R,CHOPRA S,RANKIN J.Intra-aortic balloon pump:indications,efficacy,guidelines and future directions[J].Curr Opin Cardiol,2014,29(4):285-292.
[11]OKAI I,INOUE K,MARUYAMA M,et al.Transbrachial intra-aortic balloon pumping for a patient with fulminant myocarditis[J].Heart Vessels,2012,27(6):639-642.
[12]吴颖猛,叶红雨,李斌飞,等.体外膜肺氧合治疗心脏手术后急性心功能衰竭的疗效[J].岭南心血管病杂志,2013,19(4):475-477.
[13]NUDING S,WERDAN K.IABP Plus ECMO-Is one and one more than two?[J].J Thorac Dis,2017,9(4):961-964.
[14]SCHROETER T,VOLLROTH M,H?BARTNER M,et al.[Influence of ECMO and IABP on coronary blood flow.Valuable combination or waste of resources?][J].Med Klin Intensiv Notfmed,2015,110(3):210-216.
[15]ASO S,MATSUI H,FUSHIMI K,et al.The effect of intraaortic balloon pumping under venoarterial extracorporeal membrane oxygenation on mortality of cardiogenic patients:An analysis using a nationwide inpatient database[J].Crit Care Med,2016,44(11):1974-1979.
[16]CHENG R,HACHAMOVITCH R,MAKKAR R,et al.Lack of survival benefit found with use of intra aortic balloon pump in extracorporeal membrane oxygenation:a pooled experience of1517 patients[J].J Invasive Cardiol,2015,27(10):453-458.2018-07-31
[2]ACKER M A.Mechanical circulatory support for patients with acute-fulminant myocarditis[J].Ann Thorac Surg,2001,71(3Suppl):S73-S76.
[3]LORUSSO R,CENTOFANTI P,GELSOMINO S,et al.Venoarterial extracorporeal membrane oxygenation for acute fulminant myocarditisis in adult patients:A 5-year multiinstitutional experience[J].AnnThorac Surg,2016,101(3):919-926.
[4]CHENG R,HACHAMOVITCH R,KITTLESON M,et al.Clinical outcomes in fulminant myocarditis requiring extracorporeal membrane oxygenation:a weighted meta-analysis of 170 patients[J].J Card Fail,2014,20(6):400-406.
[5]HU W,LIU C,CHEN L,et al.Combined intraaortic balloon counterpulsation and extracorporeal membrane oxygenation in 2patients with fulminant myocarditis[J].Am J Emerg Med,2015,33(5):736.
[6]中华医学会心血管病学分会精准医学学组,中华心血管病杂志编辑委员会,成人暴发性心肌炎工作组.成人暴发性心肌炎诊断与治疗中国专家共识[J].内科急危重症杂志,2017,23(6):443-453.
[7]MASON J W,O’CONNELL J B,HERSKOWITZ A,et al.Aclinical trial of immunosuppressive therapy for myocarditis.Themyocarditis treatment trial investigators[J].N Engl J Med,1995,333(5):269-275.
[8]GINSBERG F,PARRILLO J E.Fulminant myocarditis[J].Crit Care Clin,2013,29(3):465-483.
[9]MCCARTHY R E,BOEHMER J P,HRUBAN R H,et al.Long-term outcomeof fulminant myocarditis as compared with acute(nonfulminant)myocarditis[J].N Engl J Med,2000,342(10):690-695.
[10]IHDAYHID A R,CHOPRA S,RANKIN J.Intra-aortic balloon pump:indications,efficacy,guidelines and future directions[J].Curr Opin Cardiol,2014,29(4):285-292.
[11]OKAI I,INOUE K,MARUYAMA M,et al.Transbrachial intra-aortic balloon pumping for a patient with fulminant myocarditis[J].Heart Vessels,2012,27(6):639-642.
[12]吴颖猛,叶红雨,李斌飞,等.体外膜肺氧合治疗心脏手术后急性心功能衰竭的疗效[J].岭南心血管病杂志,2013,19(4):475-477.
[13]NUDING S,WERDAN K.IABP Plus ECMO-Is one and one more than two?[J].J Thorac Dis,2017,9(4):961-964.
[14]SCHROETER T,VOLLROTH M,H?BARTNER M,et al.[Influence of ECMO and IABP on coronary blood flow.Valuable combination or waste of resources?][J].Med Klin Intensiv Notfmed,2015,110(3):210-216.
[15]ASO S,MATSUI H,FUSHIMI K,et al.The effect of intraaortic balloon pumping under venoarterial extracorporeal membrane oxygenation on mortality of cardiogenic patients:An analysis using a nationwide inpatient database[J].Crit Care Med,2016,44(11):1974-1979.
[16]CHENG R,HACHAMOVITCH R,MAKKAR R,et al.Lack of survival benefit found with use of intra aortic balloon pump in extracorporeal membrane oxygenation:a pooled experience of1517 patients[J].J Invasive Cardiol,2015,27(10):453-458.2018-07-31