ECMO辅助急诊PCI在抢救STEMI后心脏骤停患者中的效果

Effects of ECMO-assisted emergency PCI in the rescue of patients with cardiac arrest after STEMI

目的分析体外膜肺氧合(ECMO)辅助急诊经皮冠状动脉介入治疗(PCI)在抢救急性ST段抬高型心肌梗死(STEMI)后心脏骤停患者中的应用效果。方法回顾性分析2016年8月—2021年7月期间阜宁县人民医院收治的28例ECMO辅助PCI治疗的STEMI后心脏骤停患者的临床资料。对比ECMO植入前后血流动力学水平变化及动脉血气指标。统计治疗情况及临床结局。结果与ECMO植入前相比,ECMO植入后15 min、1 h、12 h、24 h及48 h心率(HR)、平均动脉压(MAP)均升高(P<0.05),中心静脉压(CVP)则均降低(P<0.05);ECMO植入后1 h HR、CVP及MAP均趋于平稳。ECMO植入前后动脉血氧酸碱度(pH)值无明显变化(P>0.05);与ECMO植入前相比,ECMO植入后15 min、1 h、12 h、24 h及48 h动脉血氧饱和度(SaO_(2))均升高(P<0.05);与ECMO植入前相比,ECMO植入后1 h、12 h、24 h及48 h动脉血乳酸(LAC)均降低(P<0.05);ECMO植入后1 h HR、CVP及LAC均趋于平稳。冠状动脉造影显示,28例患者中单支血管病变6例、双支血管病变13例、三支血管病变9例;梗死相关动脉:左前降支13例、右冠状动脉13例、左主干13例、左回旋支13例,均分别置入支架;28例患者梗死相关动脉全部再通,其中22例患者达到TIMI血流分级3级、6例患者发生慢血流或无复流。ECMO辅助支持治疗时间为(14.75±4.36)h;ECMO辅助PCI治疗的STEMI后心脏骤停住院期间总死亡率为28.57%。结论ECMO辅助PCI在抢救STEMI后心脏骤停患者可稳定血流动力学及动脉血气指标,降低患者住院期间死亡率。

Objective To analyze the effects of extracorporeal membrane oxygenation(ECMO)assisted emergency percutaneous coronary intervention(PCI)in the rescue of patients with cardiac arrest(CA)after acute ST-segment elevation myocardial infarction(STEMI).Methods 28 patients with CA after acute SYEMI,aged(56.83±9.72),underwent ECMO implantation.When hemodynamic stability and spontaneous heartbeat were resumed PCI was conducted.Before and 15 min,1 h,12 h,24 h,and 48 h after the ECMO implantation multi-function monitor was used to monitor the heart rate(HR),central venous pressure(CVP),and mean arterial pressure(MAP),automatic blood gas analyzer was used to monitor the pH of arterial blood,arterial oxygen saturation(SaO_(2)),and arterial level of lactate(LAC).If the hemodynamic status succeeded to keep stable the apparatus could be drawn tentatively,however,if the condition failed to keep stable,ECMO should be re-used.The outcome was recorded.Results 20 of the 28 patients succeeded to undergo weaning of the apparatus,recovered,and were discharged,5 patients died after weaning of the apparatus,and 3 patients died of MODS.22 patients reached TIMI blood flow classification level 3,and 6 patients had slow blood flow or no reflow.The time of ECMO adjuvant support treatment was(14.75±4.36)h.The overall mortality rate during hospitalization for cardiac arrest after STEMI with ECMO-assisted PCI treatment was 28.57%.15 min,1 h,12 h,24 h,and 48 h after ECMO implantation,the HR and MAP levels were significantly higher than those before ECMO implantation,and the CVP value was significantly lower(all P<0.05);the pH level did not change significantly;the levels of SaO_(2) were significantly higher,and the levels of LAC were significantly lower(all P<0.05).And the HR,CVP and MAP values all remained stable since 1 h after ECMO implantation.Conclusion ECMO-assisted PCI stabilizes the hemodynamics and arterial blood gas indicators in the patients with CA after STEMI,and reduces the mortality of patients during hospitalization.