摘要
目的分析体外膜肺氧合(ECMO)联合急诊经皮冠状动脉介入治疗(PCI)在急性心肌梗死后心脏停搏中的应用效果。方法选取2014年4月—2017年4月十堰市太和医院收治的急性心肌梗死后心脏停搏患者58例,根据患者家属意愿分为ECMO组22例与常规心肺复苏(CCRP)组36例。两组患者均行CCRP,CCRP 10 min后,ECMO组患者行ECMO,CCRP组患者继续行CCRP,待两组患者自主循环恢复后均行急诊PCI。比较两组患者心脏停搏类型、CCRP地点、自主循环恢复情况、首次医疗接触(FMC)时间、病变部位、多支病变发生情况、主动脉内球囊反搏(IABP)情况、支架置入情况、替罗非班使用情况、PCI成功率,随访1个月生存率,术后1、3 d格拉斯哥昏迷量表(GCS)评分和术后1个月格拉斯哥-匹兹堡脑功能表现分级(CPC)。结果两组患者心脏停搏类型、CCRP地点比较,差异无统计学意义(P>0.05);ECMO组患者自主循环恢复率高于CCRP组(P<0.05)。两组患者FMC时间、病变部位、多支病变者所占比例、支架置入者所占比例、替罗非班使用率、PCI成功率比较,差异无统计学意义(P>0.05);ECMO组患者IABP治疗者所占比例低于CCRP组(P<0.05)。绘制Kaplan-Meier生存曲线显示,ECMO组患者术后1个月生存率高于CCRP组(P<0.05)。ECMO组患者术后1、3 d GCS评分高于CCRP组,术后1个月CPC优于CCRP组(P<0.05)。结论 ECMO联合急诊PCI在急性心肌梗死后心脏停搏中的应用效果较好,可有效提高患者心肺复苏成功率和生存率,改善患者神经功能,促进脑功能恢复。
Objective To analyze the application effect of extracorporeal membrane oxygenation（ ECMO） combined with emergency PCI on cardiac arrest caused by acute myocardial infarction（ AMI）. Methods A total of 58 cardiac arrest patients caused by AMI were selected in Taihe Hospital of Shiyan from April 2014 to April 2017,and they were divided into A group（ n = 22） and B group（ n = 36） according to the family members＇ will. Patients of the two groups received conventional cardio-pulmonary resuscitation（ CCRP） for 10 minutes,then patients of A group received ECMO,while patients of B group received continuous CCRP; after restoration of spontaneous circulation,patients of the two groups received emergency PCI. Types of cardiac arrest,sites for CCRP,restoration status of spontaneous circulation,first medical contact（ FMC） time,diseased regions,proportion of patients with multi-vessel lesions, usage of intra-aortic ballon pump（ IABP）, stent implantation condition,usage of tirofiban,success rate of PCI,survival rate after 1-month follow-up,GCS score after 1 day and 3 days of PCI,and Glasgow-Pittsburgh Brain Function Classification（ CPC） after 1 month of PCI were compared between the two groups. Results No statistically significant differences of types of cardiac arrest or sites for CCRP was found between the two groups（ P〈0. 05）; restoration rate of spontaneous circulation of A group was statistically significantly higher than that of B group（ P〈0. 05）. No statistically significant differences of FMC time,diseased regions,proportion of patients with multi-vessel lesions,stent implantation rate,utilization rate of tirofiban or success rate of PCI was found between the two groups（ P〈0. 05）,while utilization rate of IABP of A group was statistically significantly lower than that of B group（ P〈0. 05）. Kaplan-Meier survival curve showed that,survival rate of A group was statistically significantly higher than that of B group after 1-month follow-up（ P〈0. 05）. GCS score of A group was statistically significantly higher than that of B group after 1 day and 3 days of PCI,respectively,meanwhile CPC of A group was statistically significantly better than that of B group after 1 month of PCI（ P〈0. 05）. Conclusion ECMO combined with emergency PCI has good application effect in treating cardiac arrest caused by AMI,can effectively improve the success rate of cardio-pulmonary resuscitation,survival rate and neurological function,promote the recovery of brain function.
出处
《实用心脑肺血管病杂志》
2017年第10期88-91,共4页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
湖北省自然科学基金资助项目(2016CDB07802)
关键词
心脏停搏
心肌梗死
体外膜肺氧合
经皮冠状动脉介入治疗
治疗结果
Heart arrest
Myocardial infarction
Extracorporeal membrane oxygenation
Percutaneous coronaryintervention
Treatment outcome
