体外膜肺氧合联合经肱动脉主动脉内球囊反搏联合房间隔造口术救治心原性休克1例

Extracorporeal membrane oxygenation combined with transbrachial insertion of intra-aortic balloon counterpulsation for the treatment of cardiogenic shock:a case report

静脉-动脉体外膜肺氧合(VA-ECMO)动脉端常经股动脉插管,与主动脉生理血流方向相反,使心脏后负荷增大,进而致使左心室血液排出受阻,导致左心室压力负荷增加、左心室扩张、左心室壁应力增加,此现象称为左心室卸载不足。左心室舒张末期压力升高可导致心内膜缺血,从而阻碍左心功能的恢复。在心肌梗死或心肌炎引起的心原性休克患者中,心功能恢复更加困难。因此,VA-ECMO辅助下对心原性休克患者救治时实施左心室卸载就显得尤为重要。本文报道1例VA-ECMO救治急性心肌梗死合并心原性休克过程中联合使用主动脉内球囊反搏(IABP)和房间隔造口实施左心室卸载,且患者股动脉入路困难,使用经左侧肱动脉路径置入IABP,最终救治成功的案例。

In the vein-artery model,extracorporeal membrane oxygenation(ECMO)is often cannulated through the femoral artery in the opposite direction to the physiological blood flow of the aorta,which leads to an increase in the cardiac afterload,which in turn results in an obstruction of blood flow from the left ventricle,this leads to an increase in left ventricular pressure load,left ventricular dilatation,and left ventricular wall stress,a phenomenon known as left ventricular unloading insufficiency.Increased left ventricular end-diastolic pressure can lead to endocardial ischemia,which hinders the recovery of left ventricular function.Recovery of cardiac function is more difficult in Cardiogenic shock patients with myocardial infarction or myocarditis.Therefore,it is very important to unload the left ventricle during the treatment of Cardiogenic shock patients assisted by VA-ECMO.This paper reports a successful case of VA-ECMO in the treatment of acute myocardial infarction with Cardiogenic shock left ventricular unloading by intra-aortic balloon pump(IABP)and atrial septostomy,IABP was implanted through the left brachial artery in this case because of the difficulty of femoral artery access.