郭自同.体外膜肺氧合辅助下高危冠心病介入治疗的疗效观察[J].内科急危重症杂志,2019,25(6):454-457
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| DOI：10.11768/nkjwzzzz20190605 |
| 中文关键词: 体外膜肺氧合 高危冠心病 经皮冠状动脉介入术 并发症 |
| 英文关键词: |
| 基金项目:新疆自治区区域协同创新专项（No:201701882） |
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| 中文摘要: |
| 目的：观察38例体外膜肺氧合（ECMO）辅助下高危冠心病经皮冠状动脉介入术（PCI）的疗效。方法：术前评估病情，预防性植入ECMO，所有ECMO植入均由心内科介入医生穿刺植入，必要时联合主动脉内球囊反搏泵（IABP），然后进行PCI，术中肝素化，观察ECMO转机情况，观察转速、流量，及时调整ECMO鞘管位置，术前、中、后监测活化凝血时间（ACT），根据手术情况，决定ECMO是否术后即可拔除或维持，并对所有患者进行1~2年随访。结果：所有患者PCI均获得成功，术中2例出现慢血流，冠脉内给予硝酸甘油200μg，血流恢复正常，1例患者出现低血压，给予多巴胺、去甲肾上腺素等药物对症后均恢复；术后院内死亡3例，其中1例患者术后12h因脑出血死亡；1例患者因合并室间隔穿孔、多脏器衰竭3d后死亡；1例患者为左主干急性闭塞，择期PCI后，发生重度肺部感染，心原性休克，术后37d死亡。院外随访1~2年，2例因恶性心律失常猝死。其余33例存活，其中12例患者行冠脉造影复查，1例出现支架内闭塞，1例出现支架内再狭窄，再次支架植入治疗成功。结论：ECMO辅助下高危冠心病患者PCI相对安全有效，但要积极预防脑出血等相关并发症的发生。 |
| 英文摘要: |
| Objective: To observe the effect of percutaneous coronary intervention (PCI) in 38 patients with high risk coronary heart disease (CHD) assisted by extracorporeal membrane oxygenation (ECMO). Methods: The patients were evaluated before operation, and ECMO was implanted prophylactically. All ECMO implants were inserted by the interventional cardiologist. If necessary, intra-aortic balloon pump (IABP) was combined. PCI was performed, and heparinization was carried out during the operation. ECMO rotation, rotation speed and flow were observed, and ECMO sheath position was adjusted in time. Activated coagulation time (ACT) was monitored before, during and after the operation. ECMO was determined according to the operation. Patients were followed up for 1-2 years. Results: PCI was successful in all patients. Two patients had slow blood flow during the operation, and the blood flow returned to normal after nitroglycerin (200μg) was given to coronary artery. One patient had hypotension, and returned to normal after dopamine and noradrenaline were adminstrated. Three patients died in the hospital after the operation: 1 died of cerebral hemorrhage 12h later, 1 died of ventricular septal perforation and multiple organ failure 3 days later, and 1 died of acute occlusion of the left main trunk, severe lung sensation after selective PCI, and cardiogenic shock 37 days later. Two patients died of sudden death due to malignant arrhythmia after 1-2 years of follow-up outside the hospital. The remaining 33 patients survived, 12 of them had coronary angiography reexamination, 1 had stent occlusion, 1 had stent restenosis, and stent implantation was successful. Conclusion: PCI is relatively safe and effective in patients with high-risk CHD assisted by ECMO, but we should actively prevent the occurrence of cerebral hemorrhage and other related complications. |
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