体外膜肺氧合用于危重经皮冠状动脉介入治疗

Application of extracorporeal membrane oxygenation for critical percutaneous coronary intervention treatment

目的总结体外膜肺氧合（ECMO）在危重患者经皮冠状动脉介入治疗（PCI）中应用的经验。方法 2012年1月至2013年3月6例危重冠心病患者在PCI术中使用ECMO辅助,回顾性分析其临床资料,调查患者基本情况、辅助原因、辅助时间、并发症及预后。结果 6例患者均在ECMO辅助下顺利完成PCI术,辅助时间34~96 min,术中血流动力学平稳,平均动脉压（MAP）70~90mm Hg,术中未出现心室颤动、呼吸心搏骤停、心脏压塞等PCI术中严重并发症。6例患者分别置入支架2~4枚。1例患者因肾功能不全于PCI术毕通过ECMO管路连接超滤器行改良超滤以预防对比剂肾病。所有患者术后均顺利停机并撤除ECMO,术后1~3 d心力衰竭的症状得到控制,可平卧,无心绞痛发作。1例患者术前合并肺部感染,因感染加重于术后1个月死亡,其余5例患者康复出院。结论 ECMO可以为危重PCI患者提供有效支持治疗,但需充分评估病情,及时适度应用。

Objective To summarize the clinical effect and experience of extracorporeal membrane oxygenation（ ECMO） support for critical percutaneous coronary intervention（ PCI） treatment. Methods From January 2012 to March 2013,6 patients with critical coronary heart disease for perioperative PCI treatment received ECMO support,Retrospective summary and analysis of the clinical data of these patients were done in demographics,mechanical circulatory assist duration,complications and in-hospital mortality. Results Six patients were successfully finished the operation and weaned off from ECMO after operation. One patient died. Conclusions ECMO can supply effective support treatment for patients with PCI treatment,but detailed assessment of condition and intime appropriate use are required.