張耀仁Yan-Zin Chang李柏松Po-Sung Li醫學研究所碩士班2026-10-292030-08-0520252025-06-26https://handle.ncl.edu.tw/11296/t95h2vhttps://scholars.csmu.edu.tw/handle/123456789/36740背景： 急性冠心症（Acute Coronary Syndrome, ACS）合併心因性休克的病人，死亡率極高。機械性循環支持（Mechanical Circulatory Support, MCS）如主動脈內氣球幫浦（Intra-Aortic Balloon Pump, IABP）與體外膜氧合裝置（Extra-Corporeal Membrane Oxygenation, ECMO）常作為血流維持方法，但實際效果與風險仍有爭議。方法： 本研究為單中心回溯性分析，納入2014至2023年間於急診接受心導管治療之ACS重症病人1324例。依其是否使用MCS分為四組（未使用、使用IABP、使用ECMO、合併使用IABP及ECMO），分析其基本特徵與死亡率差異，並建構預測死亡之風險模型。結果： 總體住院死亡率為8.6%。使用MCS者之死亡率顯著上升。其中IABP單用、ECMO單用、IABP及ECMO合併使用者死亡率分別為33.7%、60.6%與57.7%。Logistic regression分析發現，血小板、左心室射出分率(Left Ventricular Ejection Fraction, LVEF)、年齡、紅血球分布寬度(Red Blood Cell Distribution Width, RDW)、乳酸值、以及使用MCS與死亡率具高度關聯。預測模型ROC AUC達0.850，具良好預測能力，未來可作為臨床風險分層工具，輔助MCS使用時機決策。結論： MCS策略在ACS重症病人中與預後密切相關，但其應用仍需個別化評估。PEARLS 風險模型(P:血小板、E:左心室射出分率、A:年齡、R:紅血球分布寬度、L:乳酸值、以及S:使用MCS)有助於臨床早期辨識高風險病人，整合年齡、LVEF、乳酸值與就醫方式等因子，提升重症ACS病人的整體預後。未來可應用於決策支持與治療優化。Background: Patients with acute coronary syndrome (ACS) complicated by cardiogenic shock face high in-hospital mortality. Mechanical circulatory support (MCS), such as intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO), is frequently used, though its efficacy and timing remain controversial.Methods: This retrospective single-center study analyzed 1,324 critically ill ACS patients who underwent emergency percutaneous coronary intervention (PCI) between 2014 and 2023. Patients were categorized into four groups based on MCS use (none, IABP, ECMO, IABP plus ECMO). Demographics, mortality outcomes, and logistic regression models were used to evaluate risk factors and develop mortality prediction models.Results: The overall in-hospital mortality rate was 8.6%. Patients receiving ECMO and combined IABP with ECMO had significantly higher mortality rates (33.3% and 57.7%, respectively). Multivariate analysis identified platelet, LVEF, age, RDW, lactate, and MCS use as independent predictors of mortality. The revised PEARLS model demonstrated good discriminatory performance (ROC AUC: 0.850).Conclusion: MCS strategy is strongly associated with mortality in critically ACS patients. Individualized assessment is essential to optimize outcomes. The PEARLS model may aid early identification of high-risk patients and support clinical decision-making.機械性循環支持休克葉克膜主動脈氣球幫浦Mechanical circulatory supportshockECMOIABPthesis