目的 探讨静脉-动脉体外膜肺氧合生存预测评分（SAVE）、急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）评分联合循环生物标志物预测经静脉-动脉体外膜肺氧合（VA-ECMO）治疗急性心肌梗死合并心源性休克（AMICS）患者90 d生存预后中的临床应用价值。 方法 选取2020年9月至2024年9月新乡市中心医院收治的136例AMICS患者为对象，均行VA-ECMO治疗，并随访90 d（随访起始时间为VA-ECMO置管当天），观察患者生存情况，根据生存情况分为生存组和死亡组。比较生存组、死亡组一般资料、SAVE评分、APACHE Ⅱ评分、低密度脂蛋白、乳酸、C反应蛋白（CRP）、心肌钙蛋白1（cTn1）、脑钠肽（BNP）水平。采用多因素Cox回归分析VA-ECMO治疗AMICS患者死亡的影响因素，受试者工作曲线（ROC）评估相关指标在VA-ECMO治疗AMICS患者90 d生存预后中的临床应用价值，Kaplan-Meier法绘制生存曲线，Log-rank检验比较不同组患者的生存差异。 结果 136例患者90 d内共死亡63例，病死率46.32%；死亡组年龄大于生存组，APACHE Ⅱ评分、低密度脂蛋白、乳酸、CRP、cTn1、BNP水平高于生存组，SAVE评分、高密度脂蛋白低于生存组（P < 0.05）；Cox回归分析显示，SAVE评分、APACHE Ⅱ评分、乳酸、CRP、cTn1均为VA-ECMO治疗后AMICS患者90 d死亡的影响因素（P < 0.05）；ROC曲线分析显示，SAVE评分、APACHE Ⅱ评分、乳酸、CRP、cTn1联合检测评估VA-ECMO治疗AMICS患者90 d死亡风险的AUC值高于单项检测（Z = 5.731、3.573、5.544、5.983、4.807，P < 0.05）；Kaplan-Meier曲线显示（死亡= 1，生存= 0），SAVE评分≤ -4.301分、APACHE Ⅱ评分> 25.076分、乳酸> 3.900 mmol/L、CRP > 23.752 mg/L、cTn1 > 7.755 ng/mL患者生存时间更短（Log-rank χ2 = 16.573、4.028、61.746、22.375、28.635，P < 0.001）。 结论 SAVE评分、APACHE Ⅱ评分、乳酸、CRP、cTn1联合检测评估VA-ECMO治疗AMICS患者90 d死亡风险的效能较高。

Objective Exploring the clinical application value of combining the Survival After Veno-Arterial Extracorporeal Membrane Oxygenation （SAVE） score， the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） score， and circulatory biomarkers in predicting 90-day survival outcomes in patients with acute myocardial infarction complicated by cardiogenic shock （AMICS） treated with veno-arterial extracorporeal membrane oxygenation （VA-ECMO）. Methods A total of 136 patients with amics admitted to the hospital from September 2020 to September 2024 were selected as the objects. All patients were treated with VA-ECMO， and were followed up for 90 days （the start time of follow-up was the day of VA-ECMO catheterization）. The survival status of the patients was observed， and they were divided into survival group and death group according to the survival status.General clinical data， SAVE scores， APACHE Ⅱ scores， and levels of low-density lipoprotein （LDL）， lactate， C-reactive protein （CRP）， cardiac troponin 1（cTn1）， and brain natriuretic peptide （BNP） were compared between the two groups. Multivariate Cox regression analysis was employed to identify factors influencing mortality in AMICS patients treated with VA-ECMO. Receiver operating characteristic （ROC） curve analysis was conducted to evaluate the clinical value of relevant indicators in predicting 90-day survival outcomes. Survival curves were generated using the Kaplan?Meier method， and the Log-rank test was used to compare survival differences between groups. Result Among 136 patients， a total of 63 died within 90 days， with a mortality rate of 46.32%； The death group was older than the survival group， with higher levels of APACHE Ⅱ score， low-density lipoprotein， lactate， CRP， cTn1， and BNP compared to the survival group， and lower levels of high-density lipoprotein and SAVE score compared to the survival group （P < 0.05）； Cox regression analysis showed that SAVE score， APACHE Ⅱ score， lactate， CRP， and cTn1 were all influencing factors for 90 day mortality in AMICS patients after VA-ECMO treatment （P < 0.05）； ROC curve analysis showed that the AUC value of the combined detection of SAVE score， APACHE Ⅱ score， lactate， CRP， and cTn1 in evaluating the 90 day mortality risk of VA-ECMO treatment for AMICS patients was higher than that of single detection （Z = 5.731， 3.573， 5.544， 5.983， 4.807， P<0.05）； Kaplan Meier curves showed that patients with SAVE score ≤ -4.301， APACHE Ⅱ score > 25.076， lactate > 3.900 mmol/L， CRP > 23.752 mg/L， and cTn1 > 7.755 ng/mL had shorter survival times （Log rank chi square =16.573， 4.028， 61.746， 22.375， 28.635， P < 0.001）. Conclusion The combined detection of SAVE score， APACHE Ⅱ score， lactate， CRP， and cTn1 has a high efficacy in evaluating the 90 day mortality risk of VA-ECMO treatment for AMICS patients.