経皮的心肺補助下にステントを挿入し救命しえた心原性ショック，持続性心室細動の1例

A Case Report of Percutaneous Cardio-pulmonary Supported Coronary Stenting Associated with Cardiogenic Shock and Ventricular Fibrillation

患者は48歳，男性．前壁心筋梗塞にて入院となった．来院時血圧は76/32mmHg，心拍数118/分・整．意識レベルJCS-2とショックであり，直ちに気管内挿管，左鼠径部より大動脈バルーンバンピング(IABP)を挿入した．その直後に心室頻拍より心室細動となった．薬物的，電気的除細動を試みるも心室細動は持続した．そこで心臓マッサージ下に右鼠径部より経皮的心肺補助(PCPS)を挿入，右上腕動脈より冠動脈造影を施行，左冠動脈前下行枝に100％の閉塞を認めた．同部に対して経皮的冠動脈形成術(PCI，ステント留置)を施行した．治療後，約2時間で心室細動は停止した．その後，心機能は徐々に改善し，数日後にはPCPS，IABP，人工呼吸器から離脱できた．心筋虚血によるショック，持続性致死的不整脈に対しPCPS下のPCIは有効な方法と考えられた．

A 48-year-old man was admitted to hospital with cardiogenic shock due to extensive myocardial infarction. Artificial respiration and intra-aortic balloon pumping(IABP) were started immediately. ECG showed ventricular fibrillation(Vf). Vf resisted treatment. Percutaneous cardio-pulmonary support(PCPS) was also started to maintain systemic circulation. A coronary angiography showed that there was 99% proximal narrowing of the left anterior descending coronary artery. Percutaneous coronary intervention(PCI) was carried out. Vf improved 2 hours after PCI. PCPS and IABP were removed within four days after PCI. PCI with PCPS is an effective treatment in a patient with extensive myocardial ischemia and recurrent Vf.