[经皮左心室辅助装置（Impella）和静脉-动脉体外膜肺氧合（VA-ECMO）成功用于缺血性心源性休克：一例报告]

[Successful Use of Percutaneous Left Ventricular Assist Device( Impella) and Veno Artery Extracorporeal Membrane Oxygenation( VA-ECMO) for Ischemic Cardiogenic Shock;Report of a Case].

作者信息

Tadakoshi Masao, Ohashi Takeki, Kageyama Souichirou, Kojima Akinori, Oshiro Norikazu, Kodani Noriko, Kawasumi Ryou, Yamaguchi Takumi

机构信息

Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan.

出版信息

Kyobu Geka. 2019 Feb;72(2):120-123.

PMID:30772876

Abstract

A 73-year-old male was referred to our hospital for acute congestive heart failure. His cardiac and respiratory conditions were worsening with cardiogenic shock requiring intubation. Coronary angiography revealed severe triple vessel disease, and echocardiography showed severe left ventricular dysfunction. Therefore, he underwent veno artery extracorporeal membrane oxygenation (VA-ECMO) followed by percutaneous left ventricular assist device (Impella). His cardiac condition improved and VA-ECMO and Impella were removed on the 2nd day and the 4th day after surgery, respectively. He underwent off-pump coronary artery bypass grafting (OPCAB) without any complication on the 36th day. Postoperative course was uneventful and he was discharged on postoperative day 30. Concomitant use of Impella and VA-ECMO (Ecpella) remarkably improved ischemic cardiogenic shock by unloading the left ventricle and increasing the cardiac output.

摘要

一名73岁男性因急性充血性心力衰竭被转诊至我院。他的心脏和呼吸状况不断恶化，出现心源性休克，需要插管。冠状动脉造影显示严重的三支血管病变，超声心动图显示严重的左心室功能障碍。因此，他接受了静脉-动脉体外膜肺氧合（VA-ECMO）治疗，随后使用了经皮左心室辅助装置（Impella）。他的心脏状况有所改善，VA-ECMO和Impella分别在术后第2天和第4天撤除。他在术后第36天接受了非体外循环冠状动脉旁路移植术（OPCAB），未出现任何并发症。术后过程顺利，他于术后第30天出院。Impella和VA-ECMO联合使用（Ecpella）通过减轻左心室负荷和增加心输出量，显著改善了缺血性心源性休克。