摘要
目的探讨体外膜肺氧合联合急诊PCI抢救急性心肌梗死后心脏骤停的效果。方法研究对象来自2015年1月至2016年10月在我院接受传统心肺复苏无效后接受急诊膜肺PCI治疗和体外膜肺氧合的患者,共40例,其中男性34例,平均年龄(57.7±14.1)岁。根据是否停用体外膜肺氧合治疗,将患者分为撤机失败组(24例)和撤机成功组(16例);根据是否院内死亡,将所有患者分为死亡组(28例)和生存组(12例)。采用Spearman相关分析方法分析患者撤机成功和生存出院的相关因素以及其相关关系。结果①传统心肺复苏时间为(45.2±24.7)min,体外膜肺氧合的使用时间为(103.2±59.5)h,其复苏成功率为100%(40/40)。②撤机失败组传统心肺复苏时间比撤机成功组长[(55.3±24.9)min比(35.7±12.1)min,P<0.01],心脏监护病房住院时间比撤机成功组短[(11.1±3.7)d比(19.8±11.5)d,P<0.01],且两组间罪犯血管分布差异有统计学意义(P<0.01)。Spearman相关分析结果显示,心脏监护病房住院时间(r=0.778,P<0.01)、罪犯血管分布(右冠状动脉r=0.609,P<0.05;左前降支r=-0.609,P<0.05)与成功撤机相关。③死亡组传统心肺复苏时间明显比生存组长[(50.9±22.0)min比(31.7±9.7)min,P<0.01],撤机比例比生存组低(P<0.01)、心脏监护病房住院时间较生存组短[(6.1±4.7)d比(12.8±10.5)d,P<0.01]。体外膜肺氧合辅助后48h平均动脉压较生存组低[(64.3±17.3)mm Hg比(88.3±18.7)mmHg,P<0.01],动脉乳酸水平明显比生存组高[(6.43±5.11)mmol/L比(1.76±0.84)mmol/L,P<0.01],且两组间罪犯血管分布的差异具有统计学意义(P<0.05)。spearman相关分析结果显示,心脏监护病房住院时间(r=0.709,P<0.01)、罪犯血管为右冠状动脉(r=0.585,P<0.05)、成功撤除体外膜肺氧合(r=0.832,P<0.01)、体外膜肺氧合辅助后48h平均动脉压(r=0.593,P<0.05)与生存出院呈正相关关系。结论体外膜肺氧合联合急诊PCI抢救急性心肌梗死后心脏骤停的效果良好,可以在临床上推广使用。
Objective To explore the effects of extracorporeal membrane oxygenation used in combination with emergent percutaneous coronary intervention on patients with cardiac arrest on account of acute myocardial infarction.Methods The clinical data of 40 subjects from January 2015 to October 2016 were analyzed in this study.All subjects were involved in our hospital and undergone extracorporeal membrane oxygenation used in combination with emergent percutaneous coronary intervention after conventional cardiopulmonary resuscitation failing.Among 40 patients whose mean age was (57.7±14.1)years old,there were 34males.According to the results of removing extracorporeal membrane oxygenation,the patients were divided into non-weaned group (24 cases)and weaned group (16 cases).According to the results of in-hospital,the patients were divided into non- survivor group (28 cases)and survivor group (12 cases).The related factors linked with weaning from extracorporeal membrane oxygenation and survival of in-hospital were analyzed with Spearman rank correlation test.Results (1)The mean duration of conventional cardiopulmonary resuscitation and extracorporeal membrane oxygenation was respectively (45.2±24.7)min and (103.2±59.5)h and the rate of success of anabiosis was 100% (40/40).(2)Compared with weaned group,the duration of conventional cardiopulmonary resuscitation was significantly longer [(55.3±24.9)min vs.(35.7±12.1)min,P<0.01]and the stay time of cardiac care unit was shorter [(11.1±3.7)d vs.(19.8±1 1.5)d,P<0.01]and there was significant difference in culprit vessel distribution between two groups (P<0.01).The stay time of cardiac care unit (r=0.778,P<0.01)and culprit vessel distribution (right coronary artery r=0.609,P<0.05;anterior descending artery r=-0.609,P<0.05)were correlated with weaned patients.(3)Compared with survivor group,the duration of conventional cardiopulmonary resuscitation was significantly longer[(50.9±22.0)min vs.(31.7±9.7)min,P<0.01]and weaning rate was lower(P<0.01)and the stay time of cardiac care unit was shorter [(6.1±4.7)d vs.(12.8±10.5)d,P<0.01]in non-survivor group. What's more,the mean blood pressure of non-survivor group was significantly lower than survivor group [(64.3±17.3)mm Hg vs.(88.3±18.7)mm Hg,P<0.01]while the lactic acid level in arterial blood 48 hours after extracorporeal membrane oxygenation support was higher than survivor group [(6.43±5.11)mmol/L vs.(1.76±0.84)mmol/L];and there was significantly difference in culprit vessel distribution between two groups (P<0.05). The stay time of cardiac care unit (r=0.709,P<0.01)and culprit vessel of right coronary artery (r=0.585,P< 0.05),rate of weaning success (r=0.832,P<0.01)and the mean blood pressure at 48 hours after extracorporeal membrane oxygenation establishment (r=0.593,P<0.05)were positively correlated with survival.Conclusion Extracorporeal membrane oxygenation used in combination with emergent percutaneous coronary intervention on patients with cardiac arrest on account of acute myocardial infarction is an effective therapeutic method,which can be used widely clinically.
作者
鄞松峰
陈太碧
谢惠晗
黄明勇
YIN Song-feng;CHEN Tai-bi;XIE Hui-han(Department of Emergency,Hospital of Integrated Traditional Chinese and Western Medicine in Changjiang Li Autonomous County,Changjiang 572700,China)
出处
《中国心血管病研究》
CAS
2018年第11期1023-1028,共6页
Chinese Journal of Cardiovascular Research
关键词
体外膜肺氧合
急诊经皮冠状动脉介入治疗
心肌梗死
心脏骤停
Extracorporeal membrane oxygenation
Emergent percutaneous coronary intervention
Myocardial infarction
Cardiac arrest
