2021 年第 2 期 第 16 卷

体外膜肺氧合联合经皮冠状动脉介入抢救急性心肌梗死后心脏骤停患者临床结局的影响因素分析

Analysis the influencing factors of clinical outcome of extracorporeal membrane oxygenation combined with percutaneous coronary intervention in rescue of cardiac arrest patients with acute myocardial infarction

作者：梁茜茜王宝玉刘畅

英文作者：Liang Qianqian Wang Baoyu Liu Chang

单位：郑州大学附属郑州中心医院郑州市中心医院急诊重症监护病房450007

英文单位：Emergency Intensive Care Unit Zhengzhou Central Hospital Affiliated to Zhengzhou University Zhengzhou Central Hospital Zhengzhou 450007 China

关键词：急性心肌梗死；心脏骤停；体外膜肺氧合；经皮冠状动脉介入

英文关键词：Acutemyocardialinfarction;Cardiacarrest;Extracorporealmembraneoxygenation;Percutaneouscoronaryintervention

• 摘要：

• 目的 探究体外膜肺氧合（ECMO）联合经皮冠状动脉介入（PCI）抢救急性心肌梗死后心脏骤停患者临床结局的影响因素。方法 收集2018年1月至2020年1月于郑州大学附属郑州中心医院采用ECMO联合急诊PCI治疗的43例AMI后心脏骤停患者的临床资料行回顾性分析。根据患者术后临床结局分为死亡组（24例）和存活组（19例）。比较2组患者的一般临床资料、临床救治情况及植入ECMO装置24、48、72 h的血流动力学、动脉血气、血液指标。采用单因素和多因素Logistic回归方法 分析影响患者临床结局的因素，用筛选出的独立危险因素构建列线图预测模型并验证。结果 2组患者传统心肺复苏（CCPR）时间、病变血管支数、罪犯血管的分布、心脏骤停至植入ECMO装置时间、心内科重症监护病房住院时间差异均有统计学意义（均P<0.05）。植入ECMO装置后24 h和48 h存活组平均动脉压（MAP）显著高于死亡组［（81±12）mmHg（1 mmHg=0.133 kPa）比（73±18）mmHg、（90±20）mmHg比（64±18）mmHg］，差异均有统计学意义（均P<0.05）。罪犯血管为左前降支、病变血管支数为左主干+三支、CCPR时间≥40 min、心脏骤停至植入ECMO装置时间≥50 min、ECMO复苏后48 h的MAP＜70 mmHg均是导致患者死亡的独立危险因素（均P<0.05）。列线图模型预测死亡率为72.6%，模型评价的实际一致性指数为0.869，内部验证一致性指数为0.861，外部验证一致性指数为0.848，模型符合度较好。结论 罪犯血管位置、病变血管支数、CCPR时间、心脏骤停至植入ECMO装置时间、ECMO复苏后48 h的MAP均是ECMO联合PCI抢救急性心肌梗死后心脏骤停患者临床结局的独立影响因素。

• Objective To explore the influencing factors of clinical outcome of extracorporeal membrane oxygenation(ECMO) combined with percutaneous coronary intervention(PCI) in rescue of cardiac arrest patients with acute myocardial infarction (AMI). Methods The clinical data of 43 cardiac arrest patients with AMI treated by ECMO combined with emergency PCI in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2018 to January 2020 were retrospectively analyzed. According to the clinical outcome, the patients were divided into death group(24 cases) and survival group(19 cases). The general clinical data, clinical treatment status, hemodynamics, arterial blood gas, and blood indexes of ECMO device implanted at 24, 48, 72 h were compared between the two groups. Single factor and multivariate Logistic regression analysis were used to analyze the factors affecting the clinical outcome of patients. The independent risk factors were screened out to construct and verify the nomogram prediction model.Results  There were statistically significant differences in conventional cardiopulmonary resuscitation(CCPR) time, number of diseased vessels, distribution of culprit vessels, time from cardiac arrest to implantation of ECMO device, and length of stay in cardiology intensive care unit between the two groups(all P<0.05). At 24 h and 48 h after ECMO device implantation mean arterial pressures (MAP) in survival group were significantly higher than those in death group［（81±12）mmHg vs （73±18）mmHg, （90±20）mmHg vs （64±18）mmHg］(both P<0.05). The independent risk factors for death included left anterior descending artery of the criminal, left main artery plus three vessels of the lesion, CCPR time ≥40 min, cardiac arrest ≥50 min from implantation of ECMO device, and MAP<70 mmHg 48 h after ECMO resuscitation (all P<0.05). The predicted mortality rate of the model was 72.6%. The actual consistency index of the model evaluation was 0.869, the internal verification consistency index was 0.861, and the external validation consistency index was 0.848, and the model conformity was good. Conclusion The distribution of culprit vessel, the number of diseased vessels, the time of CCPR, the time from cardiac arrest to ECMO device implantation, and the MAP 48 h after ECMO resuscitation are all independent influencing factors that affect the clinical outcome of ECMO combined with PCI in the rescue of cardiac arrest patients with AMI.