心肺停止症例に対するPCPSの治療成績 Emergent application of percutaneous cardiopulmonary support system in cardiac arrest patients
経皮的心肺補助装置 (percutaneous cardiopulmonary support system: PCPS) の緊急使用例76例の治療成績について検討した。疾患は急性心筋梗塞が36例と最も多かった。PCPSからの離脱は33例 (43.4%) , 生存は20例 (26.3%) であった。心停止に対する使用は院内心肺停止27例, 来院時心肺停止例9例, 来院直後の心肺停止7例の計43例であった。離脱はそれぞれ4例 (14.8%) , 4例 (44.4%) , 3例 (42.9%) , 合計25.6%であった。1カ月生存例はそれぞれ2例 (7.4%) , 3例 (33.3%) , 2例 (28.6%) , 合計16.3%であった。離脱, 生存例ともに心肺停止からPCPS開始までの時間は60分以内で, PCPS開始前の動脈血base excess値は-20mmol/<I>l</I>以内であった。PCPSは心肺蘇生の有力な手段であるが, 心停止後早期の使用が必要である。
To evaluate the emergent application of percutaneous cardiopulmonary support system (PCPS), we reviewed 43 patients applied with PCPS for refractory cardiac arrest from August 1992 to December 1999. Cardiac arrest occurred outside the hospital (group A) in 9 patients, immediately after the arrival at our emergency department (group B) in 7 patients and after the hospitalization (group C) in 27 patients. The causes of cardiac arrests were acute myocardial infarction in 25, trauma in 4 and pulmonary embolism in 2 patients. Eleven of 43 patients were able to wean successfully from PCPS within two days and seven of eleven survived more than 1 month. Six of seven survivors fully recovered and returned to their usual lives. The ratio of successful weaning from PCPS was 44.4% in group A, 42.9% in group B and 14.8% in group C. The survival ratio was 33.3% in group A, 28.6% in group B and 7.4% in group C. All of the survivors were placed on PCPS within 60 minutes after cardiac arrest. The base excess value of arterial blood gas analysis before the initiation of PCPS was less than -20 mmol/<I>l</I> in all survivors. The site of coronary artery lesion in acute myocardial infarction played a major role in mortality. Excellent survival was noted in patients who had cardiac arrest during cardiac catheterization. In 2 patients fully recovered in group A, bystander CPR began immediately after the cardiac arrest and their initial electrocardiograms showed ventricular fibrillation. The early application of PCPS seems to lead to improved survival in patients with witnessed cardiac arrest who had bystander CPR.
蘇生 20(2), 161-166, 2001-07-20