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目的：分析静脉-动脉体外膜肺氧合(venous-arterial extracorporeal membrane oxygenation, VA-ECMO)在急性心肌梗死(acute myocardial infarction, AMI)合并心源性休克(cardiogenic shock, CS)患者中的临床疗效及预后影响因素。方法：回顾性纳入2019年2月—2025年2月在南通大学附属南通第三医院接受VA-ECMO联合经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)治疗的AMI-CS患者41例，根据28 d生存情况分为存活组(n=21)与死亡组(n=20)。收集两组患者基线资料、血流动力学指标、超声心动图、实验室指标及并发症数据，进行组间比较与统计分析。结果：存活组的APACHEⅡ评分、序贯器官衰竭评分(sequential organ failure assessment, SOFA)、乳酸水平、血管活性药物评分(vasoactive-inotropic score, VIS)及相同时间点肌钙蛋白I(cardiac troponin I, cTnI)水平明显低于死亡组；相同时间点的脉压差高于死亡组；相同时间点的床旁即时超声指标中二尖瓣收缩期位移(mitral annular plane systolic excursion, MAPSE)、三尖瓣收缩期位移(tricuspid annular plane systolic excursion, TAPSE)、左室流出道速度时间积分(left ventricular outflow tract velocity time integral, LVOT-VTI)、左室射血分数(left ventricular ejection fraction, LVEF)值优于死亡组；并发症方面存活组呼吸机相关性肺炎(ventilator-associated pneumonia, VAP)发生率高于死亡组，而急性肾损伤(acute kidney injury, AKI)发生率更低；两组患者发病距开通血管时间、罪犯血管及手术方式差异无统计学意义。结论：VA-ECMO联合PCI可为AMICS患者提供有效循环支持，早期血流动力学稳定、心功能恢复及低器官损伤与存活相关。高VIS评分、高乳酸水平及AKI是预后不良的潜在预测因素。
Abstract：Objective: To analyze the clinical efficacy and prognostic factors of venous-arterial extracorporeal membrane oxygenation(VA-ECMO) in patients with acute myocardial infarction(AMI) complicated by cardiogenic shock(CS). Methods: A retrospective study was conducted on 41 AMI-CS patients who received VA-ECMO combined with percutaneous coronary intervention(PCI) at Affiliated Nantong Hospital 3 of Nantong University from February 2019 to February 2025. Patients were categorized into survival group(n=21) and non-survival group(n=20) based on 28-day survival status. Baseline characteristics, hemodynamic parameters, echocardiographic data, laboratory parameters, and complication data were collected from both groups for intergroup comparison and comprehensive statistical analysis. Resu lts: The survival group demonstrated significantly lower APACHEⅡ scores, sequential organ failure assessment(SOFA) scores, lactate levels, vasoactive-inotropic scores(VIS), and cardiac troponin I(cTnI) levels at comparable time points compared to the non-survival group. Additionally, the survival group exhibited higher pulse pressure at matched time points. Echocardiographic parameters including mitral annular plane systolic excursion(MAPSE), tricuspid annular plane systolic excursion(TAPSE), left ventricular outflow tract velocity time integral(LVOTVTI), and left ventricular ejection fraction(LVEF) were significantly superior in the survival group. In terms of complications, the survival group exhibited a higher incidence of ventilator-associated pneumonia(VAP) compared with the mortality group, whereas the incidence of acute kidney injury(AKI) was significantly lower. No statistically significant differences were observed between the two groups regarding the time interval from symptom onset to vessel reperfusion, culprit vessel characteristics, or specific surgical procedures employed. Conclusion: VA-ECMO combined with PCI provides effective circulatory support for AMI-CS patients. Early hemodynamic stabilization, recovery of cardiac function, and minimal organ damage are significantly associated with improved survival outcomes. Elevated VIS scores, high lactate levels, and AKI represent potential predictive factors for poor prognosis in this patient population.
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基本信息:
DOI：10.16424/j.cnki.cn32-1807/r.2026.02.006
中图分类号:R542.22;R541.64
引用信息:
[1]徐俊贤,王亚东,田李均,等.静脉-动脉体外膜肺氧合治疗急性心肌梗死合并心源性休克的临床效果与预后分析[J].南通大学学报(医学版),2026,46(02):131-136.DOI:10.16424/j.cnki.cn32-1807/r.2026.02.006.
基金信息:
南通市卫生健康委员会科研项目(MS2024061,MSZ2024060)
2026-03-15
2026-03-15