廉坤,谢炜巍,陈根锐,王欢,王博,刘丽媛,赵帅,陶凌,高好考,李成祥

• 1:空军军医大学西京医院心血管内科

摘要(Abstract)：

目的观察体外膜肺氧合(ECMO)联合主动脉内球囊反搏(IABP)下行择期经皮冠状动脉介入治疗(PCI)用于复杂高危冠心病患者的中期效果。方法回顾性分析空军军医大学西京医院心血管内科2018年5月至2019年11月采用ECMO联合IABP辅助下行择期PCI的38例复杂高危冠心病患者的资料。PCI术前置入ECMO及IABP,术后24 h内撤离ECMO,IABP辅助至患者生命体征平稳后撤离。收集患者住院期间临床资料(年龄、性别、体重指数、血压、心率、肝功能、肾功能、血糖、血脂、超声心动图、既往病史、手术情况及用药情况等)及主要不良心血管事件(MACE,包括全因死亡、非致死性心肌梗死及临床症状驱动的血运重建)。PCI术后1个月、6个月随访,记录MACE及超声心动图数据。结果 38例患者平均年龄(66.89±11.32)岁,男性占81.58%。既往心肌梗死19例(50.00%)、PCI病史10例(26.32%)、冠状动脉旁路移植术(CABG)史2例(5.26%),左心室射血分数(40.41±12.63)%。左主干病变24例(63.16%),慢性完全闭塞病变32例(84.21%),严重三支病变27例(71.05%)。手术成功率97.37%,完全血运重建4例(10.53%),ECMO辅助时间(7.38±3.72)h;术中心搏骤停1例(2.63%),术中心脏压塞死亡1例(2.63%)。术后出现并发症6例(15.79%),院内MACE 2例(5.26%),均为死亡。共随访6个月,1个月时发生MACE 7例(20.0%),均为死亡;左心室射血分数较术前显著改善[(48.39±12.40)%比(40.41±12.63)%,P<0.05];6个月时无MACE存活率为100%。结论 ECMO联合IABP能够在PCI围术期提供有效的血流动力学支持,其辅助下择期PCI用于复杂高危冠心病中期疗效尚可。

关键词(KeyWords)： 体外膜肺氧合;主动脉内球囊反搏;复杂高危冠心病;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目（81670229、81570210）;国家自然科学基金青年项目（81600356、81702733）;; 白求恩-默克糖尿病研究基金（G2017044）;; 心馨心血管健康基金会“进·阶基金”（2019-CCA-ACCESS065）

作者(Author): 廉坤,谢炜巍,陈根锐,王欢,王博,刘丽媛,赵帅,陶凌,高好考,李成祥

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