ECMO联合IABP对急性心肌梗死合并心源性休克患者心肺复苏比率及肌酸激酶峰值的影响

    Effects of ECMO combined with IABP on cardiopulmonary resuscitation rate and peak creatine kinase in patients with acute myocardial infarction complicated with cardiogenic shock

      摘要
    • 摘要:
      目的  分析体外膜肺氧合（ECMO）联合主动脉球囊反搏（IABP）对急性心肌梗死合并心源性休克患者心肺复苏比率及肌酸激酶峰值的影响。
      方法  随机将2020年7月～2023年11月就诊于新疆医科大学第一附属医院的126例急性心肌梗死合并心源性休克患者分为IABP组（n=63）和联合组（n=63），IABP组进行IABP治疗，联合组联合IABP与ECMO进行治疗，两组患者在体征平稳后均行经皮冠状动脉介入（PCI）进行血运重建。治疗前后检测两组患者的心肌功能左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室收缩功能（LVSF）、左心室射血分数（LVEF）、血流动力学心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、心肌酶心肌肌钙蛋白（cTnT）、肌酸激酶同工酶（CK-MB）、炎症因子肿瘤坏死因子（TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（hs-CRP），并统计患者出现的并发症例数、存活率及休克持续时间。
      结果  经过治疗后，联合组的LVEDD、LVESD、HR、CVP、cTnT、CK-MB、TNF-α、IL-6、hs-CRP显著低于IABP组，LVSF、LVEF、MAP显著高于IABP组（均P<0.01），两组患者治疗中出现的并发症比例无显著差异，但联合组的存活率显著高于IABP组（P<0.05），且休克持续时间显著低于IABP组（P<0.01）。
      结论  ECMO联合IABP可以有效增强急性心肌梗死合并心源性休克患者的心肺功能，降低炎症反应，稳定患者生命体征。

       

      Abstract:
      AIM To analyze the effects of extracorporeal membrane oxygenation (ECMO) combined with intra-aortic balloon pump (IABP) on cardiopulmonary resuscitation rate and peak creatine kinase in patients with acute myocardial infarction complicated with cardiogenic shock.
      METHODS A total of 126 patients with acute myocardial infarction complicated with cardiogenic shock who visited our hospital from July 2020 to November 2023 were randomly separated into an IABP group (n=63) and a combination group (n=63). The IABP group received IABP treatment, while the combination group received a combination of IABP and ECMO treatment. After stable physical signs, both groups underwent percutaneous coronary intervention (PCI) for revascularization. Before and after treatment, myocardial function left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular systolic function (LVSF), left ventricular ejection fraction (LVEF), hemodynamics heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), myocardial enzymes cardiac troponin (cTnT), creatine kinase isoenzyme (CK-MB) and inflammatory factors tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (hs-CRP) were detected in both groups, and the number of patients with concurrent complications, the survival rate and the duration of shock were counted.
      RESULTS After treatment, LVEDD, LVESD, HR, CVP, cTnT, CK-MB, TNF-α, IL-6 and hs-CRP in the combination group were greatly lower than those in the IABP group, while LVSF, LVEF and MAP were greatly higher than those in the IABP group (both P<0.01). There was no great difference in the proportion of complications between the two groups during treatment. However, the survival rate in the combination group was greatly higher than that in the IABP group (P<0.05), and the duration of shock was greatly lower than that in the IABP group (P<0.01).
      CONCLUSION ECMO combined with IABP effectively enhances the cardiorespiratory function, reduces inflammatory response and stabilizes vital signs in patients with acute myocardial infarction complicated with cardiogenic shock.

       

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