体外心肺复苏在急性心肌梗死并心脏骤停中的应用

Application of extracorporeal cardiopulmonary resuscitation in acute myocardial infarction with cardiac arrest

目的了解体外心肺复苏(ECPR)在急性心肌梗死(AMI)并心脏骤停的应用。方法选取2020年8月至2022年4月广州市花都区人民医院收治的13例AMI并接受静脉动脉体外膜肺氧合(VA-ECMO)治疗的患者作为研究对象,根据患者是否同时实施心肺复苏术,将其分为常规的ECMO组(n=6)及ECPR组(n=7),ECMO组采用VA-ECMO治疗,ECPR组采用VA-ECMO辅助心肺复苏术治疗。比较两组患者的一般资料、实验室指标、治疗情况、冠脉病变情况、撤机成功率、死亡率及并发症发生率。结果ECPR组患者术后急性生理及慢性健康评价Ⅱ(APACHEⅡ)评分高于ECMO组,差异有统计学意义(P<0.05);ECMO组患者术后1 h血乳酸水平高于ECMO组,差异有统计学意义(P<0.05)。两组患者的撤机成功率、死亡率、并发症发生率比较,差异无统计学意义(P>0.05)。结论早期接受ECMO治疗的AMI患者抢救成功率高,患者的早期识别与治疗,对预后十分重要。而APACHEⅡ评分、ECMO术后1 h血乳酸水平可能是影响ECPR预后的因素。

Objective To investigate the application of extracorporeal cardiopulmonary resuscitation(ECPR)in acute myocardial infarction(AMI)with cardiac arrest.Methods A total of 13 patients who suffered from AMI and received venous-arterial extracorporeal membrane oxygenation(VA-ECMO)in Huadu District People's Hospital of Guangzhou from August 2020 to April 2022 were selected as research objects,they were divided into the conventional ECMO group(n=6)and the ECPR group(n=7)according to whether the patients was performing cardiopulmonary resuscitation at the same time.The ECMO group was treated with VA-ECMO,and the ECPR group was treated with VA-ECMO assisted extracorporeal cardiopulmonary resuscitation.General data,laboratory indicators,treatment situation,coronary artery disease,success rate of debridement,mortality and incidence of complications were compared between two groups.Results The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score of patients after operation in ECPR group was higher than that in ECMO group,and the difference was statistically significant(P<0.05).The blood lactic acid level of patients in ECMO group was higher than that in ECMO group at 1 h after operation,and the difference was statistically significant(P<0.05).However,there were no significant differences in weaning success rate,mortality rate and complication rate between two groups(P>0.05).Conclusion The early ECMO treatment in patients with AMI has a high success rate of rescue,so the early identification and treatment of patients is very important to the prognosis.Further more,the APACHEⅡscore and the blood lactic acid level 1 h after ECMO start may be factors affecting the prognosis of ECPR.