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
陈鑫宇,徐俊杰,徐承义,马小静,刘成伟
摘要(Abstract):
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。
关键词(KeyWords): 急性心肌梗死;心原性休克;主动脉内球囊反搏;体外膜肺氧合
基金项目(Foundation): 湖北省武汉市科技局项目(2019020701011422);; 武汉市心血管影像临床医学研究中心2023年度开放基金立项项目(CMRC202305)
作者(Author): 陈鑫宇,徐俊杰,徐承义,马小静,刘成伟
参考文献(References):
- [1]中国医师协会急诊医师分会,国家卫健委能力建设与继续教育中心急诊学专家委员会,中国医疗保健国际交流促进会急诊急救分会.急性冠脉综合征急诊快速诊治指南(2019)[J].中华急诊医学杂,2019,28(4):421-428.DOI:10.3760/cma.j.issn.1671-0282.2019.04.003.
- [2] Puri K,Adachi I. Left heart decompression on extracorporeal membrane oxygenation support and cardiopulmonary bypass[J]. Pediatr Crit Care Med,2021,22(12):e599-e604.DOI:10.1097/PCC.0000000000002846.
- [3] Ok YJ,Jung SH,Lee SW,et al. Efficacy of left heart decompression during extracorporeal membrane oxygenation:a case-control study[J]. J Thorac Dis,2019,11(3):865-872.DOI:10.21037/jtd.2019.01.110.
- [4] Delmas C,Vallee L,Bouisset F,et al. Use of percutaneous atrioseptotosmy for left heart decompression during veno-arterial extracorporeal membrane oxygenation support:an observational study[J]. J Am Heart Assoc,2022,11(17):e024642.DOI:10.1161/JAHA.121.024642.
- [5] Cevasco M,Takayama H,Ando M,et al. Left ventricular distension and venting strategies for patients on venoarterial extracorporeal membrane oxygenation[J]. J Thorac Dis,2019,11(4):1676-1683. DOI:10.21037/jtd.2019.03.29.
- [6]于坤,龙村,黑飞龙,等.体外膜肺氧合结合左心减压治疗心脏术后重症心衰[J].中国体外循环杂志,2010,8(1):21-24. DOI:10.13498/j.cnki.chin.j.ecc.2010.01.008.
- [7]黑飞龙,龙村,于坤.体外膜肺氧合并发症研究[J].中国体外循环杂志,2005(4):243-245. DOI:10.3969/j.issn.1672-1403.2005.04.016.
- [8] Richardson ASC,Tonna JE,Nanjayya V,et al. Extracorporeal cardiopulmonary resuscitation in adults. Interim guideline consensus statement from the Extracorporeal Life Support Organization[J]. ASAIO J,2021,67(3):221-228.DOI:10.1097/MAT.0000000000001344.
- [9]杜润,张瑞岩,沈卫峰.体外膜肺氧合联合主动脉内球囊反搏行经皮冠状动脉介入治疗急性心肌梗死患者左主干分叉病变1例[J].中国介入心脏病学杂志,2018,26(4):237-238.DOI:10.3969/j. issn.1004-8812. 2018.04.011.
- [10] Urschel CW,Eber L,Forrester J,et al. Alteration o f mechanical performance of the ventricle by intraaortic balloon counterpulsation[J]. Am J Cardiol,1970,25(5):546-551. DOI:10.1016/0002-9149(70)90593-x.
- [11] Karami M,Eriksen E,Ouweneel DM,et al. Long-term5-year outcome of the randomized IMPRESS in severe shock trial:percutaneous mechanical circulatory support vs. intraaortic balloon pump in cardiogenic shock after acute myocardial infarction[J]. Eur Heart J Acute Cardiovasc Care,2021,10(9):1009-1015. DOI:10.1093/ehjacc/zuab060.
- [12] Delmas C,Vallee L,Bouisset F,et al. Use of percutaneous atrioseptotosmy for left heart decompression during veno-arterial extracorporeal membrane oxygenation support:an observational study[J]. J Am Heart Assoc,2022,11(17):e024642.DOI:10.1161/JAHA.121.024642.
- [13] Amancherla K,Menachem JN,Shah AS,et al. Limited balloon atrial septostomy for left ventricular unloading in peripheral extracorporeal membrane oxygenation[J]. J Card Fail,2021,27(4):501-504. DOI:10.1016/j.cardfail.2020.12.014.
- [14]李丁扬,张刚成,沈群山,等.经皮房间隔造口左心引流在静-动脉体外膜肺氧合治疗中的应用[J].中华胸心血管外科杂志,2020,36(2):89-93. DOI:10.3760/cma.j.issn.1001-4497.2020.02.005.
- [15]卢才义.临床心血管介入操作技术[M]北京:科学出版社,2002:114-115.
- [16]张安吉,李成祥,袁铭.经肱动脉、股动脉两种途径行直接经皮冠状动脉介入术治疗急性ST段抬高性心肌梗死的对比研究[J].实用医学杂志,2009,25(20):3420-3422. DOI:10.3969/j.issn.1006-5725.2009.20.024.
- [17] No?l BM,Gleeton O,Barbeau GR. Transbrachial insertion of an intra-aortic balloon pump for complex coronary angioplasty[J].Catheter Cardiovasc Interv,2003,60(1):36-39;discussion40. DOI:10.1002/ccd.10606.
- [18]吴铿,游琼,郑锡锋,等.经肱动脉与经股动脉路径进行主动脉内球囊反搏术治疗急性心肌梗死合并心源性休克患者的对比研究[J].中国介入心脏病学杂志,2014,22(2):106-110. DOI:10.3969/j.issn.1004-8812.2014.02.009.