VA-ECMO联合IABP在急性心肌梗死PCI术后并发难治性心源性休克中的治疗效果观察

Observation of the Therapeutic Effect of VA-ECMO Combined with IABP in Refractory Cardiogenic Shock after PCI in Acute Myocardial Infarction

目的分析静动脉体外膜肺氧合(VA-ECMO)联合主动脉内球囊反搏(IABP)在急性心肌梗死冠状动脉介入(PCI)术后并发难治性心源性休克中的治疗效果观察。方法将2021年10月至2023年10月南阳市中心医院收治的急性心肌梗死PCI术后并发难治性心源性休克患者(86例)纳入为研究对象,依据随机单双数抽签法分组,43例单数者入对照组,仅采取IABP治疗;另外43例双数者入研究组,采取VA-ECMO联合IABP治疗。对比两组存活率、ICU住院时间、治疗有效率、治疗前后心功能指标[心输出量(CO)、每搏输出量(SV)、左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)]、并发症发生情况。结果研究组存活率(95.35%)高于对照组(79.07%),ICU住院时间短于对照组,差异有统计学意义(P<0.05);研究组治疗有效率(93.02%)高于对照组(74.42%),差异有统计学意义(P<0.05);治疗前两组心功能指标对比差异无统计学意义(P>0.05),治疗后研究组CO、LVEF、SV水平高于对照组,左室收缩末期、舒张末期内径小于对照组,差异有统计学意义(P<0.05);研究组并发症发生率(2.33%)低于对照组(16.28%),差异有统计学意义(P<0.05)。结论VA-ECMO、IABP联用在急性心肌梗死PCI术后并发难治性心源性休克患者中具有较高的应用价值,可提升患者存活率,促进心功能恢复且并发症发生率低,值得应用。

Objective To analyze the therapeutic effect of veno-arterial extracorporeal membrane oxygenation(VA-ECMO)combined with intra-aortic balloon pump(IABP)in refractory cardiogenic shock following percutaneous coronary intervention(PCI)for acute myocardial infarction.Methods Eighty-six patients with refractory cardiogenic shock following PCI for acute myocardial infarction treated at Nanyang Central Hospital from October 2021 to October 2023 were randomly divided into two groups.The control group(n=43)received IABP treatment alone,while the study group(n=43)received VA-ECMO combined with IABP treatment.Survival rate,ICU length of stay,treatment efficacy,cardiac function indicators[cardiac output(CO),stroke volume(SV),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)],and incidence of complications were compared between the two groups.Results The survival rate in the study group(95.35%)was higher than that in the control group(79.07%),and ICU length of stay was shorter in the study group,with statistically significant differences(P<0.05).The treatment efficacy rate in the study group(93.02%)was higher than that in the control group(74.42%),with statistically significant differences(P<0.05).Before treatment,there were no significant differences in cardiac function indicators between the two groups(P>0.05).After treatment,CO,LVEF,and SV levels were higher,and LVESD and LVEDD were lower in the study group compared to the control group,with statistically significant differences(P<0.05).The incidence of complications in the study group(2.33%)was lower than that in the control group(16.28%),with statistically significant differences(P<0.05).Conclusion The combination of VA-ECMO and IABP has high application value in patients with refractory cardiogenic shock following PCI for acute myocardial infarction,improving survival rates,promoting cardiac function recovery,and reducing complication rates,making it worth applying.