苏利芳,支伟,高恒波,肖浩,刘畅畅,周庆,汪雁博,谷新顺

• 1:河北医科大学第二医院心内科
• 2:河北医科大学第二医院急诊科

摘要(Abstract)：

目的 探索影响体外膜肺氧合（ECMO）联合经皮冠状动脉介入治疗（PCI）ST段抬高型心肌梗死（STEMI）合并心原性休克（CS）患者预后的因素。方法 回顾性分析2019年5月至2023年7月于河北医科大学第二医院心内科就诊应用ECMO联合PCI治疗的STEMI合并CS患者的临床资料，根据患者住院期间的生存情况分为存活组和死亡组，比较两组患者的临床资料。结果 该研究共分析了37例患者，男34例，平均年龄为（52.4±11.7）岁，存活组15例，死亡组22例，存活率为40.5%。与死亡组患者相比，存活组入院时的收缩压[（100.6±17.7）mmHg比（84.6±22.0）mmHg,P=0.025]及舒张压[（64.5±11.8）mmHg比（54.3±16.0）mmHg,P=0.043]更高，从休克至ECMO上机时间更长[4.0(3.0,1 0.0)h比2.8(1.9,5.1)h,P=0.048]，从ECMO上机至导丝通过时间更短[1.5(0.5,3.0)h比3.8(2.3,7.0)h,P=0.008]，首帧TIMI血流分级达Ⅲ级的比例更高[9(60.0%)比5(22.7%),P=0.038]。死亡组患者谷丙转氨酶[261.8(100.1,944.9)U/L比106.6(27.4,193.3)U/L,P=0.033]和谷草转氨酶[753.6(432.7,1533.0)U/L比244.7(113.7,594.3)U/L,P=0.009]均明显高于存活组。结论 从ECMO上机至导丝通过时间、首帧TIMI血流分级是影响ECMO联合PCI治疗STEMI合并CS患者预后的重要因素。

关键词(KeyWords)： ST段抬高型心肌梗死;心原性休克;体外膜肺氧合;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 河北省政府资助临床医学优秀人才培养项目（ZF2023152）

作者(Author): 苏利芳,支伟,高恒波,肖浩,刘畅畅,周庆,汪雁博,谷新顺

参考文献(References)：

• [1]Babaev A,Frederick PD,Pasta D J,et al.Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock[J].JAMA,2005,294(4):448-454.DOI:10.1001/jama.294.4.448.
• [2]Awad HH,Anderson FA Jr,Gore JM,et al.Cardiogenicshock complicating acute coronary syndromes:insights from the global registry of acute coronary events[J].Am Heart J,2012,163(6):963-971.DOI:10.1016/j.ahj.2012.03.003.
• [3]Samsky MD,Morrow DA,Proudfoot AG,et al.Cardiogenic shock after acute myocardial infarction a review[J].JAMA,2021,326(18):1840-1850.DOI:10.1001/jama.2021.18323.
• [4]Lemor A,Ya'qoub L,Basir MB,et al.Mechanical circulatory support in acute myocardial infarction and cardiogenic shock[J].Interv Cardiol Clin,2021,10(2):169-184.DOI:10.1016/j.iccl.2020.12.005.
• [5]Ouweneel DM,Eriksen E,Sjauw KD,et al.Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction[J].J Am Coll Cardiol,2017,69(3):278-287.DOI:10.1016/j.jacc.2016.10.022.
• [6]Sattler S,Khaladj N,Zaruba MM,et al.Extracorporal life support(ECLS)in acute ischaemic cardiogenic shock[J].Int J Clin Pract,2014,68(4):529-531.DOI:10.1111/ijcp.12380.
• [7]Sheu JJ,Tsai TH,Lee FY,et al.Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock[J].Crit Care Med,2010,38(9):1810-1817.DOI:10.1097/CCM.0b013e3181e8acf7.
• [8]Neumann FJ,Sousa-Uva M,Ahlsson A,et al.2018ESC/EACTS guidelines on myocardial revascularization[J].EuroIntervention,2019,14(14):1435-1534.DOI:10.4244/EIJY19M01 01.
• [9]Thy ge sen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction(2018)[J].Eur Heart J,2019,40(3):237-269.DOI:10.1093/eurheartj/ehy462.
• [10]中华医学会心血管病学分会心血管急重症学组,中华心血管病杂志编辑委员会.心原性休克诊断和治疗中国专家共识(2018)[J].中华心血管病杂志,2019,47(4):265-277.DOI:10.3760/cma.j.issn.0253-3758.2019.04.003
• [11]Schmidt M,Burrell A,Roberts L,et al.Predicting survival after ECMO for refractory cardiogenic shock:the survival after venoarterial-ECMO(SAVE)-score[J].Eur Heart J,2015,36(33):2246-2256.DOI:10.1093/eurheartj/ehv194.
• [12]Tsao NW,Shih CM,Yeh JS,et al.Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock[J].J Crit Care,2012,27(5):530.el-530.e11.DOI:10.1016/j.jcrc.2012.02.012.
• [13]Cheng R,HachamovitchR,KittlesonM,et al.Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest:a meta-analysis of 1 866adult patients[J].Ann Thorac Surg,2014,97(2):610-616.DOI:10.1016/j.athoracsur.2013.09.008.
• [14]Sohail S,Fan E,Foroutan F,et al.Predictors of mortality in patients treated with veno-arterial ECMO for cardiogenic shock complicating acute myocardial infarction:a systematic review and meta-analysis[J].J Cardiovasc Transl Res,2022,15(2):227-238.DOI:10.1007/s12265-021-10140-w.
• [15]中国医师协会体外生命支持专业委员会,成人体外氧合循环辅助专家共识[J].中华医学杂志,2018,98(12):886-894.DOI:10.3760/cma.j.issn.0376-2491.2018.12.003.
• [16]Thiele H,Zeymer U,Neumann FJ,et al.Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock(IABP-SHOCKⅡ):final 12 month results of arandomised,open-labeltrial[J].Lancet,2013,382(9905):1638-1645.DOI:10.1016/S0140-6736(13)61783-3.
• [17]Lawton JS,Tamis-Holland JE,Bangalore S,et al.2021 ACC/AHA/SCAI guideline for coronary artery revascularization:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J].J Am Coll Cardiol,2022,79(2):e21-e129.DOI:10,1016/j.jacc.2021.09.006.
• [18]McDonagh TA,Metra M,Adamo M,et al.2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J].Eur Heart J,2021,42(36):3599-3726.DOI:10.1093/eurheartj/ehab 3 68.
• [19]Meertens MM,Tichelbacker T,Macherey-Meyer S,et al.Meta-analysis of extracorporeal membrane oxygenation in combination with intra-aortic balloon pump vs.extracorporeal membrane oxygenation only in patients with cardiogenic shock due to acute myocardial infarction[J].Front Cardiovasc Med,2023,9:1104357.DOI:10.3389/fcvm.2022.1104357.
• [20]潘晨亮,赵晶,胡思雄,等.急性心肌梗死合并心原性休克患者应用VA-ECMO联合IABP的时机探索[J].中华心血管病杂志,2023,51(8):851-858.DOI:10.3760/cma.j.cn112148-20230706-00396.
• [21]Thiele H,Zeymer U,Akin I,et al.Extracorporeal life support in infarct-related cardiogenic shock[J].N Engl J Med,2023,389(14):1286-1297.DOI:10.1056/NEJMoa2307227.
• [22]Zeymer U,Freund A,Hochadel M,et al.Venoarterial extracorporeal membrane oxygenation in patients with infarctrelated cardiogenic shock:an individual patient data metaanalysis of randomised trials[J].Lancet,2023,402(10410):1338-1346.DOI:10.1016/S0140-6736(23)01607-0.