禹天同,赵帅,陈焱,陈有虎,陈根锐,王欢,张博晖,张玺,朱伯达,韩鹏,高好考,廉坤,李成祥

• 1:中国人民解放军空军军医大学第一附属医院心血管内科
• 2:中国人民解放军西部战区空军医院心血管内科
• 3:中国人民解放军海军第971医院心血管内科
• 4:陕西中医药大学公共卫生学院

摘要(Abstract)：

目的 比较复杂高危冠心病患者在体外膜肺氧合（ECMO）联合主动脉内球囊反搏（IABP）辅助下行经皮冠状动脉介入治疗（PCI）的远期疗效及预后结局，探讨联合应用器械循环支持（MCS）装置在复杂PCI中的价值。方法 连续纳入2018年1月至2022年12月于中国人民解放军空军军医大学第一附属医院心血管内科经冠状动脉造影诊断并符合入选标准的在MCS下行择期PCI的患者，根据术中MCS方式分为ECMO+IABP组和单纯IABP组。收集患者临床特征、造影特征、术中结果及并发症等资料，观察患者术后院内结果和1个月及1年主要不良心血管事件（MACE），分析两组间上述指标的差异并分析独立危险因素。结果 共纳入218例行择期PCI的患者，其中ECMO+IABP组66例，单纯IABP组152例。两组患者的基线资料基本相当，ECMO+IABP组患者的病变特征更加复杂，合并心房颤动（6.1%比0.7%,P=0.030）、左主干病变（43.9%比27.0%,P=0.018）、三支病变（90.9%比75.7%,P=0.009）、右冠状动脉（RCA）病变（98.5%比86.8%,P=0.005）及RCA慢性完全闭塞病变（60.6%比35.5%,P<0.001）的比例均高于单纯IABP组，单纯IABP组既往行PCI的比例更高（32.9%比16.7%,P=0.014）。两组患者院内并发症总体发生率的差异无统计学意义（P=0.176），但是ECMO+IABP组术后低血压的发生率更高（19.7%比9.2%,P=0.031）。两组患者术后1个月MACE(4.5%比2.6%,P=0.435)和1年MACE(7.6%比7.9%,P=0.936)的发生率相当。Firth修正的多因素分析显示，院内发生心肺复苏（OR 7.17,95%CI1.27～40.38,P=0.025）和术后低血压（OR3.60,95%CI1.10～11.83,P=0.035）是发生术后1年MACE的独立危险因素。结论 联合应用ECMO+IABP支持可使复杂高危冠心病患者获得通过PCI完成血运重建的机会并获得临床获益，远期预后满意。

关键词(KeyWords)： 经皮冠状动脉介入治疗;体外膜肺氧合;主动脉内球囊反搏;主要不良心血管事件

Abstract:

Keywords:

基金项目(Foundation): 西京医院医务人员培养助推项目（XJZT24LY39）;; 空军军医大学临床研究项目（2022LC2208）;; 陕西省重点研发计划重点产业创新链项目（2024SF-YBXM-004）;陕西省重点研发计划一般项目（2024GX-YBXM-136）;; 青岛市医药卫生科研指导项目（2023-WJZD244）

作者(Author): 禹天同,赵帅,陈焱,陈有虎,陈根锐,王欢,张博晖,张玺,朱伯达,韩鹏,高好考,廉坤,李成祥

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