急诊体外膜肺氧合辅助下重症心肌梗死的介入治疗

Effect of extracorporeal membrane oxygenation in assistant percutaneous coronary intervention treatment of patients with acute myocardial infarction

目的探讨体外膜肺氧合辅助下对急性重症心肌梗死(AMI)患者中的行急诊经皮冠状动脉介入治疗(PCI)的疗效。方法回顾分析2003年1月至2007年12月期间中山大学附属中山医院住院的25例诊断急性心肌梗死合并心脏骤停、严重心律失常或心功能衰竭的患者,在体外膜肺氧合(ECMO)支持下行急诊PCI治疗的临床疗效观察。结果25例患者均在ECMO支持下血流动力学稳定,并成功行PCI,梗死相关动脉全部开通,20例患者血流达到TIMI3级,5例患者发生慢血流或无复流(血流TIMI0～2级)。急诊介入手术中无一例死亡,介入治疗术后住院期内死亡7例,住院期间总的死亡率为28%(7/25)。结论ECMO支持下,能促进重症AMI患者血流动力学恢复稳定,为重症患者进行PCI提供了必备的前提条件;为冠状动脉血运重建赢得了时间,从而提高了重症AMI患者的存活率。

Objective To investigate the effect of extracorporeal membrane oxygenation in assistant percutaneous curonarv intervention treatment of patients with acute myocardial infarction. Methods From January 2003 to December 2007 in Zhongshan Hospital, Twenty-five patients with acute myocardial infarction were retrospectively analyzed, aceompaning cardiac arrest, arrhythmia or heart failure. All patients were obversed the effect of extracorporeal membrane oxygenation in assistant percutaneous coronary intervention treatment. Results Twenty-five patients successfully finished percutaneous coronary intervention with stable haemodynamic support, and all infarcted vessels recirculated. Twenty cases were TIMI 3, five cases were TIMI 0-2 （slowly circulation or without recirculation）. None of patients died in the percutaneous coronary intervention operation, but seven cases died Mter operation. Conclusions Extracorporeal membrane oxygenation can offer stable haemodynamie support for successfully percutaneous coronary intervention and to improve the survival rate of patients with acute myocardial infarction.