摘要
目的探讨低射血分数(EF)高危冠心病患者应用体外膜肺氧合(ECMO)辅助行高危经皮冠状动脉介入治疗(HR-PCI)是否可以改善近期EF值以及临床预后。方法回顾性分析北部战区总医院自2018年11月至2019年7月收治的低EF值且成功行PCI的52例高危冠心病患者的临床资料。将在手术中应用ECMO辅助的患者设为观察组(n=18),未应用ECMO辅助的患者设为常规组(n=34)。比较两组患者临床基线资料及介入术中相关基线情况,术后心功能恢复情况(包括左心室大小、EF值等),院内及出院6个月时随访的临床事件发生情况等。结果两组患者临床基线资料匹配。观察组术中置入支架个数、术中低血压发生率均高于常规组,术中经皮主动脉球囊反搏术使用率低于常规组,组间比较,差异均有统计学意义(P<0.05)。两组患者术后及出院6个月时EF值均较术前升高,且观察组高于常规组,差异有统计学意义(P<0.05)。两组患者的院内病死率、6个月主要心脑血管不良事件发生率比较,差异无统计学意义(P>0.05)。观察组6个月随访时因心绞痛再入院率低于常规组,差异有统计学意义(P<0.05)。结论低EF值的高危冠心病患者行HR-PCI时应用ECMO辅助支持可行,可明显增加术后及出院6个月EF值,患者短期预后生活质量得到改善,减少因心绞痛再入院率。推测对于低EF值的高危冠心病患者而言,应用ECMO辅助支持行HR-PCI可能会改善临床预后。
Objective To investigate whether extracorporeal membrane oxygenation(ECMO)assisted high risk percutaneous coronary intervention(HR-PCI)in patients with low ejection fraction(EF)value and high risk coronary heart disease can improve the recent EF value and clinical prognosis.Methods A retrospective study was performed on 52 cases of high-risk coronary heart disease patients with low EF and underwent PCI from November 2018 to July 2019.Patients who were assisted by ECMO during surgery were set as observation group(n=18),and patients who were not assisted by ECMO were set as conventional group(n=34).The two groups of patients were compared in terms of clinical baseline data and intraoperative baseline conditions,postoperative cardiac function recovery(including left ventricular size,EF value),and clinical events followed up in hospital and 6 months after discharge.Results Clinical baseline data were matched between the two groups.The number of stents and the incidence of intraoperative hypotension in the observation group were all higher than those in the conventional group,and the utilization rate of percutaneous aortic balloon pulsation was lower than that in the conventional group,with statistically significant differences(P<0.05).EF value in both groups was higher than that before surgery and 6 months after discharge,and the EF value in the observation group was higher than that in the conventional group(P<0.05).The nosocomial fatality rate and the incidence of major cardiovascular and cerebrovascular adverse events at 6 months were compared between the two groups,and the difference was not statistically significant(P>0.05).At the 6-month follow-up,the readmission rate for angina in the observation group was lower than that in the conventional group(P<0.05).Conclusion It is feasible for ECMO to support HR-PCI in high-risk coronary heart disease patients with low EF value,which can significantly increase EF value after surgery and 6 months after discharge,improve the short-term prognosis of patients′quality of life,and reduce the readmission rate due to angina.It is speculated that HR-PCI with ECMO auxiliary support may improve the clinical prognosis of high-risk coronary heart disease patients with low EF value.
作者
关绍义
梁振洋
刘海伟
王耿
王效增
赵昕
马颖艳
王斌
徐凯
韩雅玲
荆全民
GUAN Shao-yi;LIANG Zhen-yang;LIU Hai-wei;WANG Geng;WANG Xiao-zeng;ZHAO Xin;MA Ying-yan;WANG Bin;XU Kai;HAN Ya-ling;JING Quan-min(Department of Cardiovascular Medicine,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《临床军医杂志》
CAS
2020年第10期1153-1156,1160,共5页
Clinical Journal of Medical Officers
基金
国家重点研发计划项目(2016YFC1301300)
关键词
体外膜肺氧合
心脏射血分数
高危
经皮冠状动脉介入治疗
预后
Extracorporeal membrane oxygenation
Left ventricular ejection fraction
High-risk
Percutaneous coronary intervention
Prognosis
