田峰,周珊珊,张弢,王晶,都日娜,田淬,韦妍妍,陈韵岱

• 1:解放军总医院第一医学中心心内科

摘要(Abstract)：

目的探讨主动脉内球囊反搏(IABP)联合体外膜肺氧合(ECMO)救治急性心肌梗死(AMI)合并心原性休克(CS)患者的时机和流程。方法连续纳入解放军总医院2015年1月到2019年8月诊断为AMI合并CS的患者,依次给予多巴胺和去甲肾上腺素药物治疗,置入IABP、ECMO等治疗,根据患者接受的不同治疗策略分组。主要终点为药物治疗和器械辅助治疗的住院死亡率和出院30 d死亡率,次要终点为组织灌注和酸中毒的变化情况,以及器械辅助的并发症。结果 10例IABP联合ECMO患者死亡率为30.0%,显著低于置入IABP后需要增加升压药物治疗的患者(30.0%比87.0%, P=0.001),差异有统计学意义;治愈患者出院30 d内无死亡发生。患者置入ECMO 6 h后血压和组织灌注明显改善,血乳酸水平由术前的(15.29±4.62)mmol/L下降到(4.51±1.85)mmol/L,差异有统计学意义(P<0.001),置入12 h后血乳酸降至正常。结论合理选择适应证和置入时机,采用IABP联合ECMO进行机械循环辅助治疗可降低AMI合并CS患者的死亡率。

关键词(KeyWords)： 急性心肌梗死;心原性休克;体外膜肺氧合;死亡率

Abstract:

Keywords:

基金项目(Foundation): 首都发展科研专项基金(2016-1-5011)

作者(Author): 田峰,周珊珊,张弢,王晶,都日娜,田淬,韦妍妍,陈韵岱

参考文献(References)：

• [1]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）.中华心血管病杂志，2019,47(4):265-277.
• [2] Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial in-farction with cardiogenic shock. N Engl J Med,2012,367:1287-1296.
• [3] Thiele H, Zeymer U, Thelemann N, et al. Intraaortic balloon pump in cardiogenic shock complicating acute myocardial infarction:long-term 6-year outcome of the randomized IABPSHOCKⅡtrial. Circulation, 2019, 139:395-403.
• [4]中华医学会心血管病分会，中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南（2019）.中华心血管病杂志，2019, 47(10):766-783.
• [5] Thiele H, Ohman EM, de Waha-Thiele S, et al. Management of cardiogenic shock complicating myocardial infarction:an update 2019. Eur Heart J, 2019, 40(32):2671-2683.
• [6] Cheng R, Hachamovitch R, Makkar R, et al. Lack of survival benefit found with use of intraaortic balloon pump in extracorporeal membrane oxygenation:a pooled experience of 1517 patients. J Invasive Cardiol, 2015, 27(10):453-458.
• [7] Basir MB, Schreiber T, Dixon S, et al. Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock:the detroit cardiogenic shock initiative. Catheter Cardiovasc Interv, 2018, 91(3):454-461.
• [8] Romeo F, Acconcia MC, Sergi D,et al. Percutaneous assist devices in acute myocardial infarction with cardiogenic shock:review,meta-analysis. World J Cardiol, 2016, 8(1):98-111.
• [9]胡昊，吴佳纬，李丹，等.急性心肌梗死合并心原性休克患者主动脉内球囊反搏支持下行急诊经皮冠状动脉介入治疗的临床疗效观察.中国介入心脏病学杂志，2019, 27(5):260-264.
• [10] Kim H, Lim SH, Hong J, et al. Efficacy of veno-arterial extracorporeal membrane oxygenation in acute myocardial infarctionwith cardiogenic shock. Resuscitation, 2012, 83(8):971-975.
• [11] Negi SI, Sokolovic M, Koifman E, et al. Contemporary use of veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock in acute coronary syndrome. J Invasive Cardiol, 2016, 28(2):52-57.
• [12] Chung ES, Lim C, Lee HY, et al. Results of extracorporeal membrane oxygenation(ECMO)support before coronary reperfusion in cardiogenic shock with acute myocardial infarction. Korean J Thorac Cardiovasc Surg, 2011, 44(4):273-278.
• [13] Chung SY, Tong MS, Sheu JJ, et al. Short-term and longterm prognostic outcomes of patients with ST-segment elevation myocardial infarction complicated by profound cardiogenic shock undergoing early extracorporeal membrane oxygenatorassisted primary percutaneous coronary intervention. Int J Cardiol, 2016, 223:412-417.
• [14]申华，杜俣，马晓腾，等. PIE-2R模式救治急性心肌梗死合并心原性休克患者的初步临床经验.中华医学杂志，2019, 99(28):2208-2213.
• [15] Cheng R, Hachamovitch R, Kittleson M, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest:a meta-analysis of 1,866 adult patients. Ann Thorac Surg, 2014, 97(2):610-616.