体外膜肺氧合联合导管介入治疗在高危急性肺栓塞中的应用

摘要

目的 总结体外膜肺氧合(ECMO)辅助下联合导管介入治疗在高危急性肺栓塞(APE)中的经验及治疗效果.方法 我院于2014-08 ～2016-11为4例APE患者在经口气管插管接呼吸机辅助下,行ECMO辅助联合导管介入治疗.3例患者人院时处于心脏骤停状态,1例患者处于心源性休克状态,均予以心外按压、经口气管插管接呼吸机及ECMO辅助,明确诊断为 APE后均于ECMO辅助下行导管介入治疗.2例患者行机械碎、溶栓治疗,2例患者行机械碎栓治疗,其中1例患者介入后合并胸廓内动脉分支破裂出血同期行栓塞治疗.结果 2例患者未脱离ECMO,停机后死亡;2例顺利脱离ECMO及呼吸机辅助,其中1例并发多脏器功能衰竭死亡,1例无明显并发症顺利出院,随访良好.结论 ECMO辅助下联合导管介入治疗为APE患者提供了一种有效的治疗方法,具有较好的临床救治效果.%Objective To summarize the experience and therapeutic effect of extracorporeal membrane oxygenation (ECMO) combined with catheter-based intervention in high risk acute pulmonary embolism(APE). Methods Along with ventilator support, 4 patients with high-risk APE were treated by ECMO combined with catheter-based intervention in our hospital from August 2014 to November 2016.3 patients were in cardiac arrest at the time of admission, and 1 patient was in the state of cardiac shock,both of which were supported with cardiopulmonary resuscitation,ventilation and ECMO assistance. Both of them underwent catheter-based intervention after diagnosis with APE.2 patients underwent mechanical fragmentation, thrombolytic therapy, 2 patients underwent mechanical fragmentation therapy,and 1 patient suffered from rupture bleeding of a branch of the internal thoracic artery and underwent embolization therapy during the same period. Results 2 patients did not discharged from ECMO and died after removed ECMO.2 patients were successfully discharged from ECMO and ventilator support.1 of them died with multiple organ failure, and 1 case had no obvious complications, and showed a good follow-up observation. Conclusion ECMO combined with catheter-based intervention provides an effective treatment for patients with high-risk APE,with a good clinical treatment effect.