四级递增运动对体外膜肺氧合联合主动脉球囊反搏下高危冠心病行冠状动脉介入治疗的11例临床观察

目的:探讨四级递增运动对体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）联合主动脉球囊反搏（intra aortic balloon counterpulsation，IABP）支持下高危冠心病患者行经皮冠状动脉介入治疗（percutaneous coronary int...

Clinical observation on four-level incremental exercise for 11 cases of high-risk coronary heart disease undergoing percutaneous coronary intervention under extracorporeal membrane oxygenation combined with intra aortic balloon counterpulsation

Objective　To investigate the effect of four-level incremental exercise on patientswith high-risk coronary artery disease undergoing percutaneous coronaryintervention (PCI) under extracorporeal membrane oxygenation (ECMO) combinedwith intra aortic balloon counterpulsation (IABP). Methods　A total of 11 patients with high-risk coronary artery disease treated byPCI under the joint protection of ECMO and IABP in The First Affiliated Hospitalof Henan University of CM from January 2018 to December 2020 were treated withfour-level incremental exercise, including 9 males and 2 females, aged (66±18)years. They were retrospectively summarized and intervened by earlystep-by-step exercise, level 1 exercise from the end of surgery to the time ofECMO extraction, level 2 exercise from the time of ECMO extraction to 48 hoursafter ECMO extraction, level 3 exercise from 48 hours after ECMO extraction tomoving out of coronary heart disease care unit (CCU), and level 4 exerciseafter moving out of CCU. After four-level incremental exercise, thepostoperative application of instruments, catheter application, complications,deep venous thrombosis score before surgery and before discharge (after incrementalexercise), lower limb muscle strength, score of Self-rating Anxiety Scale, andscore of Insomnia Severity Index Scale were summarized and evaluated.Comparison of the measurement data used paired t test. Results　Among the 11patients, the longest application time of ECMO was 139 hours and the longestapplication time of IABP was 206 hours. Catheter application: the centralvenous catheter was used in 11 cases, the urinary catheter was retained in 9cases, and the noninvasive ventilator was used in 2 cases. Exercise outcomes: 7patients successfully completed the training, and 4 patients completed it afterblood transfusion treatment. The score of deep venous thrombosis beforedischarge was significantly lower than that before surgery [(10.00±1.26) vs. (11.51±1.37), P=0.012], the score of Self-ratingAnxiety Scale before discharge was significantly lower than that before surgery[(48.54±8.67) vs. (67.27±11.58), P<0.001],and the score of Insomnia Severity Index Scale before discharge wassignificantly lower than that before surgery [(13.18±3.97) vs. (17.18±4.81), P=0.045]. Conclusions　Under the comprehensive evaluation and monitoring, the four-levelincremental exercise training method can improve the cardiopulmonary exercisein patients with high-risk coronary artery disease undergoing PCI under thesupport and protection of ECMO combined with IABP, improve the exerciseendurance of lower limbs, reduce the complications, and improve the quality oflife. Early exercise training can be carried out under the strict evaluationand monitoring.