体外膜肺氧合联合主动脉内球囊反搏在高危经皮冠状动脉介入治疗中的应用

Application of extracorporeal membrane oxygenation with intro-aortic balloon counterpulsation in complex high risk 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)预防性应用于高危经皮冠状动脉介入治疗(HR-PCI)患者的短期临床疗效。方法选择2018年5 8月10例HR-PCI患者,术中应用ECMO联合IABP循环支持。结果 10例患者中男性8例,女性2例,年龄51~84(70.3±11.1)岁,平均左心室射血分数(35.7±10.2)%。10例患者均为严重三支病变,左主干病变7例,其中合并右冠状动脉(RCA)慢性完全闭塞(CTO)病变 5例,前降支CTO病变 2例;剩余3例中2例为RCA和左前降支(LAD)近/中段CTO病变,1例为RCA CTO病变合并LAD/左回旋支(LCX)严重狭窄。在ECMO联合IABP支持下7例左主干病变中先处理左主干病变6例,1例处理了RAC CTO病变和LAD重度狭窄;剩余3例中2例RCA和LAD近/中段CTO病变均先处理了LAD CTO病变,另1例RCA CTO病变合并LAD/LCX严重病变患者先处理了RCA CTO病变。术中ECMO平均灌注流量(1.80±0.30)L/min,总运转时间(3.4±0.7)h。PCI平均手术时间(2.2±0.5)h。1例PCI术中发生血流动力学崩溃,ECMO灌注流量提高到3.0 L/min维持血流动力学,直到循环正常。术后所有患者ECMO均成功撤机。2例患者IABP穿刺部位血肿,其中1例术后发现假性动脉瘤;1例术后于ICU发生室性心动过速和心室颤动;无ECMO管道机械性问题、下肢缺血和感染并发症发生。结论对不适合行外科血管重建术的HR-PCI术患者,ECMO联合IABP循环支持下行PCI术是可行的。

Objective To evaluate the short-term clinical effect of extracorporeal membrane oxygenation (ECMO) combined with intra-aortic balloon counterpulsation (IABP) in complex high-risk percutaneous coronary intervention (PCI) and to provide clinical evidence for preventing complications. Methods From May to August 2018, 10 patients with critical coronary heart disease for perioperative PCI treatment were enrolled and received ECMO with IABP support. Results A total of 10 patients including 8 male patients and 2 female patients were enrolled, with a mean age of (70.3±11.1) years and the mean ejection fraction of (35.7±10.2)%, among whom, there were 7 patients with left main severe lesion, 5 patients with RCACTO and 2 patients with LAD CTO. With the assistance of ECMO and IABP, all of the patients had successfully undergone coronary revascularization and ECMO was weaned successfully after PCI in all patients. ECMO mean perfusion duration is (3.4±0.7) h and mean perfusion flow is (1.80±0.30)L/min;PCI mean procedural time is(2.2±0.5)h. One patient occurred cardiovascular collapse during PCI procedure, but ECMO generated adequate blood fl ow support until automated cardiac activity was restored. Two patients occurred groin hematoma second to large dose and long time heparin use and one of the patients with pseudoaneurysm;one patient occurred ventricular tachycardia and fi brillation after operation. No ECMO mechanical complication and procedural complication like limb ischemia and infection. All patients were discharged safely. Conclusions In highly selected patients ineligible for bypass surgery, ECMO supported PCI can be performed with promising short clinical outcome.