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ECMO联合IABP救治围产期心肌病患者1例并文献回顾
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Abstract:
围产期心肌病是一种罕见的妊娠晚期或产后女性的特发性左心室功能障碍，当药物治疗无效时可通过机械循环支持治疗为康复或心脏移植争取时间。我们报告了一名急性重症围产期心肌病病例，患者剖宫产术中发生心源性休克，术后应用大剂量升压药血压难以维持，予以ECMO、IABP改善患者心脏灌注及心室运动，最终患者5天后撤除VA-ECMO，1月后随访LVEF改善至67%。因此，在患有难治性心力衰竭的围产期心肌病患者中，机械循环支持尤其是ECMO可作为患者恢复的桥梁，缩短患者病程、改善患者预后。
Peripartum cardiomyopathy (PPCM) is a rare idiopathic left ventricular dysfunction that occurs in women during late pregnancy or the postpartum period. When pharmacological treatments are ineffective, mechanical circulatory support (MCS) can be utilized to buy time for recovery or heart transplantation. We report a case of acute severe PPCM in which the patient developed cardiogenic shock during a cesarean section. Postoperatively, despite the administration of high-dose vasopressors, her blood pressure remained unstable. Extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) were initiated to improve cardiac perfusion and ventricular function. The patient was successfully weaned off venoarterial ECMO (VA-ECMO) after 5 days, and follow-up at one month revealed significant improvement in left ventricular ejection fraction (LVEF) to 67%. This case demonstrates that mechanical circulatory support, particularly ECMO, can serve as a bridge to recovery in patients with refractory heart failure due to PPCM, potentially shortening the disease course and improving prognosis.
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