冠心病极危重患者在心脏介入治疗中的经皮心肺辅助循环支持

Coronary intervention with percutaneous cardio-pulmonary support in critical patients

目的 探讨冠心病主干病变合并心功能不全、心源性休克等极高危患者在心脏介入治疗中经皮心肺辅助循环（PCPS）支持及其可行性.方法 对5例左主干病变合并心功能不全（其中1例急性心肌梗死室间隔穿孔合并心源性休克）患者在PCPS支持下行介入治疗,经股动、静脉穿刺或切开置管后,连接体外人工心肺辅助系统,按经皮冠状动脉介入（PCI）治疗要求肝素抗凝下行PCPS系统转流,初始流速设置为15ml/（kg·min）,根据术中血流动力学和血氧饱和度指标进行调整流速.结果 PCI治疗过程中3例血流动力学稳定,1例在植入支架时出现血压急剧下降,意识丧失,经调整PCPS流速至70ml/（kg·min）后血压恢复正常,1例室间隔穿孔合并心源性休克患者在PCPS支持下血流动力学稳定.5例均成功进行PCI及室间隔穿孔封堵治疗.结论 PCPS可为冠心病极危重患者介入术中提供有效的循环支持.

Objective To investigate the feasibility of cardiac interventional therapy with percutaneous cardio-pulmonary support （PCPS） in extremely critical patients. Methods Five patients with left main coronary artery lesions complicated by cardiac insufficiency, including one with acute myocardial infarction, VSD perforation and cardiac shock underwent coronary interventional therapy with PCPS. After puncture or incision the catheter was inserted and heart-lung auxiliary system was connected. Under heparin anticoagulation PCPS system was operated with the initial flow rate of 15ml/ （kg. min）, the flow rate was adjusted according to the intraoperative hemodynamics and blood oxygen saturation index. Results Three cases had stable hemodynamics dur- ing the procedure of intervention therapy. Rapid blood pressure drop and toss of consciousness occurred during installing stent in one case, after flow of PCPS was adjusted to 70ml/ （kg.min）, the blood pressure restore to normal. In one case with ventricular septal perforation and cardiac shock, the hemodynamics was stable under the support of PCPS. The PCI and fibrobronchoscopic treatment of ventricular septal perforation were successful in all 5 cases. Conclusion PCPS provides effective intraoperative circulation support in coronary intervention for extremely critical patients.