Page 41 - 中国全科医学2022-21

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extracorporeal membrane oxygenation（ECMO） had important clinical significance for the efficacy of these patients. Objective
To explore the efficacy of IABP combined with ECMO in patients with AMI and CS and the inflencing factor of the need for ECMO
support in patients with AMI and CS. Methods A total of 91 patients with AMI and CS treated with IABP in the Coronary Care
Unit（CCU ward） of the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2020 were collected
and divided into IABP group（n=65） and IABP+ECMO group（n=26） according to the use of ECMO. The clinical data of
the patients in both groups were collected and analyzed. The 12-months survival rate of patients discharged from hospital was
followed up. The inflecting factors of AMI patients complicated with CS treated with IABP needed ECMO support by Multivariate
logistic regression analysis. Results Rate of cardiac arrest after IABP，VIS level at 24 h，survival rate at 12 months after
discharge and proportion of continuous renal replacement therapy（CRRT），tracheal intubation，pulmonary infection，lower
extremity ischemia，acute kidney injury and gastrointestinal bleeding，12-month survival rate after discharge，the use ratio of
epinepHrine and norepinepHrine in IABP group were lower than those in IABP+ECMO group（P<0.05）. And the duration of
CCU hospitalization in IABP group was shorter than that of IABP+ECMO group（P<0.05）. Age in IABP group was higher than
that of IABP+ECMO group （P<0.05）. The results of two-factor repeated measures Anova showed that the group and time had no
significant interaction effects on systolic blood pressure，diastolic blood pressure and heart rate（P>0.05）. The group and time
had significant interaction effects on lactic acid and pH（P<0.05）. The main effect of time on systolic blood pressure，diastolic
blood pressure，lactic acid and pH was significant（P<0.05）. The main effect of time on heart rate was not significant（P>0.05）.
The main effect of group on systolic blood pressure，diastolic blood pressure，heart rate，lactic acid and pH was not significant
（P>0.05）. Systolic blood pressure，pH at 24 h after treatment and 72 h after treatment were higher than that before treatment
in both groups （P<0.05）. The level of lactic acid at 24 h after treatment and 72 h after treatment was lower than that before
treatment in both groups（P<0.05）. Systolic blood pressure，pH at 72 h after treatment were higher than that at 24 h after
treatment in both groups （P<0.05）. The level of lactic acid at 72 h after treatment was lower than that at 24 h after treatmen in
both groups（P<0.05）. Systolic blood pressure of IABP+ECMO group was higher than IABP group at 72 h after treatment （P<0.05）.
The diastolic blood pressure at 24 h and 72 h after treatment in the IABP group was higher than that before the machine treatment
（P<0.05）. The IABP+ECMO group had a lower lactate level 24 hours after treatment than that in the IABP group，the pH value
was higher than that in the IABP group（P<0.05）. Multivariate logistic regression analysis showed that age，VIS level at 24 h
after treatment，and cardiac arrest after IABP could predict whether AMI patientscomplicated with CS treated with IABP needed
ECMO support（P<0.05）. Conclusions IABP combined with ECMO can improve the hemodynamic indexes and survival rate
of patients with AMI complicated with CS at 12 months after discharge. Age，24 h VIS and cardiac arrest after IABP could predict
whether AMI patients complicated with CS treated with IABP needed ECMO support.
【Key words】 Myocardial infarction；Shock，cardiogenic；Cardiovascular diseases；Intraaortic balloon pumping；
Extracorporeal membrane oxygenation；Vasoactive-inotropic score

急性心肌梗死（AMI）是心源性休克（CS）最常见 患者 ECMO 支持提供理论依据。
的病因，作为心内科一种常见的急危重症，死亡率极高。 1 对象与方法
主动脉内球囊反搏（IABP）是一种搏动泵辅助装置， 1.1 研究对象及分组 选取 2014 年 10 月至 2020 年 10
其原理是通过主动脉内球囊与心动周期同步的充气及放 月于郑州大学第一附属医院冠心病监护病房（CCU）住
气功能，达到循环辅助作用，能够增加 AMI 合并 CS 患 院的 AMI 合并 CS，早期行 PCI 且应用 IABP 的患者 91
者的心输出量，改善冠状动脉、肾脏及外周的血流灌注， 例为研究对象。纳入标准：（1）收缩压持续 <90 mm Hg
血流动力学效果肯定，是临床上应用最多的一种经皮机 （1 mm Hg=0.133 kPa） 超 过 30 min， 或 平 均 动 脉 压
械辅助装置 ［1］ 。但 IABP 对于部分病情危重患者的血流 <65 mm Hg 超过 30 min，或在血管活性药物支持下收缩
动力学支持力度不够，近年来，体外膜肺氧合（ECMO） 压 >90 mm Hg。（2）脏器灌注不足，出现以下至少一
也被广泛应用于 AMI 合并 CS 患者的治疗中，但目前国 种可诊断：①精神状态改变，早期兴奋，晚期抑制萎
内关于 IABP 联合 ECMO 在 AMI 合并 CS 患者治疗中的 靡；②皮肤和四肢湿冷、花斑；③少尿（尿量少于 17
应用经验较少，本研究通过回顾性分析 AMI 合并 CS 行 ml/h）；④血清乳酸水平高于 2.0 mmol/L。排除标准：（1）
院内早期经皮冠状动脉介入治疗（PCI）且应用 IABP 患者心肺复苏超过 30 min；（2）昏迷，非药物所致的
患者的临床资料，评价 IABP 联合 ECMO 的疗效，探讨 瞳孔扩大固定；（3）严重的外周动脉疾病，导致无法
应用 ECMO 的影响因素，以期为及时有效的给予该类 置入主动脉内球囊泵，或严重程度 > Ⅱ级的主动脉反流；