离死亡最近的血管堵塞——左主干病变引起急性心肌梗死、心源性休克的抢救

The vascular blockage closest to death-rescue of acute myocardial infarction and cardiogenic shock caused by left main artery lesion

急性心肌梗死合并心源性休克,治疗难度大、死亡率高,是心血管医生需要面对的最严重的挑战之一。其临床证据又十分有限,最优临床策略依然存在争议。本文介绍1例由左主干病变引起急性心肌梗死、心源性休克的病例抢救成功的过程,并总结了其中的关键经验:尽早实行经皮冠状动脉(冠脉)介入(percutaneous coronary intervention,PCI)开通堵塞冠脉,围手术期进行主动脉内球囊反搏(intra-aortic balloon pump,IABP)和体外膜氧合(extracorporeal membrane oxygenation,ECMO)联合辅助治疗,强调同时启动介入团队及ECMO团队,尽可能缩短进门-球囊扩张(door-to-balloon,D2B)时间,同时兼顾door to ECMO的时间。

Acute myocardial infarction(AMI)complicated with cardiogenic shock is one of the most serious challenge that cardiovascular doctors need to face.The clinical evidence is very limited,and the optimal clinical strategy is still controversial.An AMI case complicate with cardiogenic shock caused by left main artery lesion was successfully rescued in our hospital.We summarized the key experiences:percutaneous coronary intervention(PCI)should be implemented as soon as possible to open the blocked coronary artery;intra-aortic balloon pump(IABP)and extracorporeal membrane oxygenation(ECMO)adjuvant therapy should be carried out in the perioperative period;the intervention team and ECMO team should be started at the same time to shorten the door-to-balloon(D2B)time as soon as possible and take into account the time of door to ECMO.