目的探讨在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)上机初期,红细胞分布宽度(red blood cell volume distribution width,RDW)和血小板分布宽度(platelet distribution width,PDW)对急性心肌梗死患者预后的判断价值。...目的探讨在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)上机初期,红细胞分布宽度(red blood cell volume distribution width,RDW)和血小板分布宽度(platelet distribution width,PDW)对急性心肌梗死患者预后的判断价值。方法回顾性分析2017年4月至2021年7月期间接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)治疗的急性心肌梗死患者。比较不同预后患者一般情况、ECMO上机前APACHEⅡ评分、治疗期间最高的氨基末端脑钠尿肽前体(N-terminal fragment of the brain natriuretic peptide precursor,NT-proBNP)和肌钙蛋白T数值。ECMO运行后即刻监测的血红蛋白、RDW、血小板计数、PDW和平均血小板体积。并记录同时期采血检测的活化部分凝血酶原时间。比较不同预后组上述指标的差异,并采用Logistic回归分析与预后的相关性。结果入选55例,存活18例(32.8%),平均年龄(54.7±11.2)岁,其中男性48例(87.3%)。存活组上机前前APACHEⅡ评分低于死亡组(分:26.00±6.54 vs.30.54±4.35,P<0.05)。存活组RDW低于死亡组(%:12.57±0.60 vs.128.59±0.80);PDW在两组间差异无统计学意义(P>0.05)。Logistic回归分析显示,上机前APACHEⅡ评分与患者预后相关,而RDW与患者预后不相关。结论VA-ECMO支持的急性心肌梗死患者上机前APACHEⅡ评分可以预测患者预后,而RDW和PDW不适合作为患者预后判断指标。展开更多
The adverse outcomes of a ventricular heart failure(left,right or biventricular)caused by cardiogenic shock are aggravated by lung oedema and organ mal perfusion.Despite advances in medical sciences,revascularisation ...The adverse outcomes of a ventricular heart failure(left,right or biventricular)caused by cardiogenic shock are aggravated by lung oedema and organ mal perfusion.Despite advances in medical sciences,revascularisation and mechanical hemodynamic support have proved ineffective in reducing the mortality rate in such patients.A thorough study of the data available about cardio-vascular diseases reveals that the application of conventional methods of treatment are least helpful to practically restore normal functions of heart when it experiences end-stage systolic ventricular failure.Thus,to overcome the challenges and find alternatives to address this issue,percutaneous ventricular support devices/machines were designed and successfully introduced.These devices have revolutionized the treatment of ventricular heart failures and are now in use all over the world.In this review paper a newer mechanical circulatory support(MCS)device,Impella,has been discussed and compared with a few other devices like Intra-aortic Balloon Pump(IABP),Extracorporeal Circulation(ECLS)and Veno-arterial Extracorporeal Membrane Oxygenation(VA-ECMO).This article studies the challenges being faced during the treatment of cardiogenic shock,and thoroughly discusses the use and effectiveness of Impella Cardiac Axial Pump in each emergency.It can be said that mechanical circulatory support(MCS)device use during percutaneous coronary intervention(PCI)should be individualized based on multiple factors with a recommended use in patients with the greatest potential benefit and a relatively low risk of device-related complications.The current literature suggests that the outcomes of use of Impella and other mechanical circulatory support devices like IABP and VA-ECMO are comparable.Though there seem to be a few advantages of Impella over the others,sufficiently powered,multi-centric,randomised control trials are needed to establish its superiority.展开更多
文摘目的探讨在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)上机初期,红细胞分布宽度(red blood cell volume distribution width,RDW)和血小板分布宽度(platelet distribution width,PDW)对急性心肌梗死患者预后的判断价值。方法回顾性分析2017年4月至2021年7月期间接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)治疗的急性心肌梗死患者。比较不同预后患者一般情况、ECMO上机前APACHEⅡ评分、治疗期间最高的氨基末端脑钠尿肽前体(N-terminal fragment of the brain natriuretic peptide precursor,NT-proBNP)和肌钙蛋白T数值。ECMO运行后即刻监测的血红蛋白、RDW、血小板计数、PDW和平均血小板体积。并记录同时期采血检测的活化部分凝血酶原时间。比较不同预后组上述指标的差异,并采用Logistic回归分析与预后的相关性。结果入选55例,存活18例(32.8%),平均年龄(54.7±11.2)岁,其中男性48例(87.3%)。存活组上机前前APACHEⅡ评分低于死亡组(分:26.00±6.54 vs.30.54±4.35,P<0.05)。存活组RDW低于死亡组(%:12.57±0.60 vs.128.59±0.80);PDW在两组间差异无统计学意义(P>0.05)。Logistic回归分析显示,上机前APACHEⅡ评分与患者预后相关,而RDW与患者预后不相关。结论VA-ECMO支持的急性心肌梗死患者上机前APACHEⅡ评分可以预测患者预后,而RDW和PDW不适合作为患者预后判断指标。
文摘The adverse outcomes of a ventricular heart failure(left,right or biventricular)caused by cardiogenic shock are aggravated by lung oedema and organ mal perfusion.Despite advances in medical sciences,revascularisation and mechanical hemodynamic support have proved ineffective in reducing the mortality rate in such patients.A thorough study of the data available about cardio-vascular diseases reveals that the application of conventional methods of treatment are least helpful to practically restore normal functions of heart when it experiences end-stage systolic ventricular failure.Thus,to overcome the challenges and find alternatives to address this issue,percutaneous ventricular support devices/machines were designed and successfully introduced.These devices have revolutionized the treatment of ventricular heart failures and are now in use all over the world.In this review paper a newer mechanical circulatory support(MCS)device,Impella,has been discussed and compared with a few other devices like Intra-aortic Balloon Pump(IABP),Extracorporeal Circulation(ECLS)and Veno-arterial Extracorporeal Membrane Oxygenation(VA-ECMO).This article studies the challenges being faced during the treatment of cardiogenic shock,and thoroughly discusses the use and effectiveness of Impella Cardiac Axial Pump in each emergency.It can be said that mechanical circulatory support(MCS)device use during percutaneous coronary intervention(PCI)should be individualized based on multiple factors with a recommended use in patients with the greatest potential benefit and a relatively low risk of device-related complications.The current literature suggests that the outcomes of use of Impella and other mechanical circulatory support devices like IABP and VA-ECMO are comparable.Though there seem to be a few advantages of Impella over the others,sufficiently powered,multi-centric,randomised control trials are needed to establish its superiority.
