徐俊杰,徐承义,刘成伟,宋丹,鄢华,马小静

• 1:武汉科技大学附属武汉亚洲心脏病医院心内科
• 2:武汉科技大学医学部医学院

摘要(Abstract)：

目的 探讨经皮穿刺建立静脉-动脉体外膜肺氧合（VA-ECMO）路径的安全性和VA-ECMO辅助下行高危经皮冠状动脉介入治疗（HR-PCI）的有效性。方法 本研究为单中心、回顾性研究，纳入2022年12月至2023年12月在武汉亚洲心脏病医院接受VA-ECMO辅助下行HRPCI的患者，研究主要终点是经皮穿刺建立VA-ECMO路径的安全性，特征主要是体外膜肺氧合（ECMO）相关并发症，包括伤口严重出血/血肿、动静脉瘘、假性动脉瘤、外周动脉夹层及死亡等。次要终点是VA-ECMO辅助下行HR-PCI的有效性，定义为6个月随访时主要不良心脑血管事件（MACCE），包括全因死亡、非致死性心肌梗死、非计划再次血运重建、缺血性脑卒中的复合事件。结果 研究纳入189例患者，VA-ECMO导致的穿刺伤口严重出血/血肿15例（7.9%），伤口感染8例（4.2%），动静脉瘘1例（0.5%），假性动脉瘤4例（2.1%），外周动脉夹层3例（1.6%），体循环栓塞/血栓形成8例（4.2%），急性肾损伤8例（4.2%），急性神经系统损伤3例（1.6%），死亡1例（0.5%）。经皮冠状动脉介入治疗（PCI）成功182例（96.3%）,PCI相关并发症共36例（19.0%）。164例患者完成6个月随访，其中全因死亡4例（2.4%），非致死性心肌梗死11例（6.7%），非计划再次血运重建11例（6.7%），缺血性脑卒中的复合事件2例（1.2%）。结论 超声引导下经皮穿刺建立VA-ECMO路径具有较高的安全性，VA-ECMO辅助下行HR-PCI在患者中具有良好的短期效果。

关键词(KeyWords)： 高危经皮冠状动脉介入治疗;静脉-动脉体外膜肺氧合;机械循环支持;并发症

Abstract:

Keywords:

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): 徐俊杰,徐承义,刘成伟,宋丹,鄢华,马小静

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