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

The application of extracorporeal membrane oxygenation combined with intra-aortic balloon pump for high-risk patients undergoing percutaneous coronary intervention

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.