三级联动ECPR救治心肌梗死并心源性休克患者1例

Three-Level Joint System Treatment of Patients with Myocardial Infarction with Cardiogenic Shock via ECPR: A Case Report

摘要: 介绍1例广泛前壁心肌梗死致反复室颤、心源性休克年轻患者的联合救治过程。该患者急性胸痛起病，乡镇医院首诊，给予初步处理后，通过构建的县乡联合急救网络体系，迅速转运至县医院胸痛中心，直接入导管室第一时间行冠脉造影明确了急性心肌梗死的诊断。因反复室颤、顽固性心源性休克难以纠正，持续心肺复苏的同时，紧急启动ECPR联合救治流程。首先，我们用CVC导管预先建立ECMO血管通路，等上级医院ECMO设备到达后进行管路置换，为后续救治患者大大节约了时间。接下来，患者心梗“犯罪血管”成功开通，发病第6天撤离VA-ECMO并脱离呼吸机，心功能逐渐改善，无其他并发症。该患者的成功救治主要得益于“基层胸痛单元–基层胸痛中心–三级医院”急救网络体系的流程优化，在基层医疗中心无相应条件时，能够早期寻求区域高级医疗中心帮助，无缝衔接及密切配合，使得患者在ECMO支持下转运及手术，为患者良好预后提供保障。

Abstract: This article describes the combined diagnosis and treatment of a young patient with recurrent ventricular fibrillation and cardiogenic shock caused by extensive anterior myocardial infarction. The patient developed an emergency chest pain and was first diagnosed by a township hospital. After receiving initial treatment, the patient was quickly transferred to the county chest pain center through a county township joint emergency network system. The diagnosis of acute myocardial infarction was confirmed immediately by coronary angiography. Because of the recurrent ventricular fibrillation and intractable cardiogenic shock, with continuing cardiopulmonary resuscitation, the ECPR rescue process was initiated urgently. First of all, we established the ECMO vascular access in advance with CVC catheter instead, when the real ECMO equipment of the superior hospital arrived, the CVC pipelines were replaced, which greatly saved time for subsequent rescue of the patient. In the later stage, the “criminal vessel” of myocardial infarction was successfully opened. On the 6th day of onset, the patient withdrew from VA-ECMO and ventilator. His cardiac function gradually improved without any other complications. The successful treatment of this patient mainly benefits from the process optimization of “grassroots chest pain unit-chest pain centertertiary hospital” emergency network system. When there are no conditions in the grassroots medical center, they can seek help from regional advanced medical centers in the early stage, through seamlessly connection and closely cooperation, allowing patients to transfer and undergo surgery with the support of ECMO, providing guarantee for a good prognosis of patients.