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ST-Elevation Myocardial Infarction with Cardiogenic Shock Rescued by Use of Extracorporeal Membrane Oxygenation: A Case Report and Literature Review

使用體外膜氧合來援救ST段升高心肌梗塞合併心因性休克:一病例報告及文獻回顧

摘要


雖然在血栓溶解劑或經皮腔內冠狀動脈成形術的積極治療下,急性心肌梗塞的病人若合併有心因性休克,仍是造成死亡主要的原因。我們報告我們的經驗在一個ST段升高急性性心肌梗塞的病人接受成功的血管再通術後,依然有頑固性心因性休克及心室頻脈心律不整,使用體外膜氧合來當做血行動力支持。這個病人成功地脫離體外膜氧合並存活而出院。而使用體外膜氧合的主要目的在於當主動脈內氣球幫浦失敗時可再增加系統灌流、避免器官嚴重的損傷、並提供時間讓心臟得以恢複功能來增加病人的存活率。

並列摘要


Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction (AMI) despite aggressive treatment modalities such as fibrinolysis and percutaneous transluminal coronary angioplasty. We report our experience with a case of ST segment elevation AMI complicated with refractory cardiogenic shock and ventricular tachyarrhythmia even after successful revascularization using hemodynamic support with the extracorporeal membrane oxygenation (ECMO). This patient was weaned from ECMO, survived and discharged from hospital. The purpose of the ECMO is to restore the systemic perfusion while intra-aortic balloon pump failed and to avoid severe injury to the organs, and to allow time for intrinsic recovery of the heart, thus, improving the chance of survival.

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