摘要
目的:探讨预置股动静脉鞘管进行体外膜肺氧合(ECMO)床旁备机在高危经皮冠状动脉介入治疗(PCI)术中突发心脏骤停时行紧急ECMO辅助的可行性和有效性。方法:回顾性纳入2020年1月至2021年12月郑州大学第一附属医院和河南省胸科医院两个心脏中心的2120例PCI患者,其中75例(3.5%)经评估定义为高危PCI,均于术前预置股动静脉鞘管;收集并分析其中因术中突发心脏骤停而行紧急体外心肺复苏(ECPR)者的基线资料、心肺复苏(CPR)时间、ECMO操作时间、并发症、院内死亡率等相关资料。结果:在75例高危PCI患者中,15例(20.0%)因术中突发心脏骤停而进行紧急ECPR,其中男性9例,中位年龄68.50(62.75,74.25)岁。15例患者的中位CPR时间为9.50(6.50,16.25)min,ECMO上机操作时间为6.00(4.75,9.00)min,ECMO运行时间为71.0(41.5,114.5)h。15例患者全部成功撤除ECMO,其中1例因多脏器功能衰竭院内死亡,其他患者均存活出院;1例患者在ECMO运行期间出现消化道出血,2例患者出现急性肾功能损伤;经格拉斯哥-匹兹堡脑功能表现分级(CPC)评分评估,所有患者神经功能预后良好。结论:高危PCI术前预置股动静脉鞘管进行ECMO床旁备机是可行的,可显著缩短CPR时间和ECMO上机操作时间,提高患者生存率,可为PCI术中心脏骤停患者提供紧急心肺支持。
Objectives:To investigate the feasibility and effectiveness of presetting the femoral arteriovenous sheath with extracorporeal membrane oxygenation(ECMO)bedside preparation for emergency ECMO assistance in case of cardiac arrest during percutaneous coronary intervention(PCI).Methods:The study screened 2120 patients,who underwent PCI from January 2020 to December 2021 in the First Affiliated Hospital of Zhengzhou University and Henan Chest Hospital.75(3.5%)patients who underwent high-risk PCI were prewired with femoral arteriovenous sheath before PCI.The baseline data,cardiopulmonary resuscitation(CPR)time,ECMO operation time,complications,in-hospital mortality of patients who underwent emergency extracorporeal cardiopulmonary resuscitation(ECPR)due to sudden cardiac arrest were analyzed.Results:A total of 15(20.0%)patients(9 male,median age 68.50[62.75,74.25]years)underwent ECPR due to cardiac arrest during PCI.ECMO was initiated immediately upon cardiac arrest,the median CPR time was 9.50(6.50,16.25)min,median ECMO operation time was 6.00(4.75,9.00)min,median ECMO run time was 71.0(41.5,114.5)h.All 15 patients were successfully weaned from ECMO,1 patient died during hospitalization due to multiple organ failure,and the rest 14 patients survived.One patient developed gastrointestinal bleeding during ECMO,2 patients developed renal impairment,and Glasgow-Pittsburgh cerebral performance categories(CPC)score was satisfactory in all patients post ECPR.Conclusions:Presetting femoral arteriovenous sheath with ECMO bedside preparation is feasible and effective for ECPR during high-risk PCI.It can significantly shorten the time of CPR and ECMO,and improve the survival rate.It can provide emergency cardiopulmonary support for patients with cardiac arrest during PCI.
作者
孟丽
刘闯
李杏杏
赵晖
MENG Li;LIU Chuang;LI Xingxing;ZHAO Hui(Comprehensive Intensive Care Unit,Henan Chest Hospital,Zhengzhou(450003),Henan,China)
出处
《中国循环杂志》
CSCD
北大核心
2023年第1期49-52,共4页
Chinese Circulation Journal
关键词
预置股动静脉鞘管
高危
经皮冠状动脉介入治疗
心脏骤停
体外心肺复苏
体外膜肺氧合
preset femoral arteriovenous sheath
high-risk
percutaneous coronary intervention
cardiac arrest
extracorporeal cardiopulmonary resuscitation
extracorporeal membrane oxygenation
