主动脉球囊反搏在急性心肌梗死所致的心源性休克和心脏破裂中的应用

目的 对采用主动脉内球囊反搏（IABP）治疗的心源性休克和心脏破裂病人的住院死亡情况进行回顾性分析。方法 对心源性休克和心脏破裂的28例病人，均安装IABP，其中20例进行了冠状动脉造影。13例接受了冠状动脉成形术（PTCA），冠脉旁路移植术（CABG）或心脏外科手术。结果 1例因急诊血管成形失败而行急诊CABG成功，11例急诊血管成形（直接PTCA）开通了梗死相关动脉（IRA），12例（42.9%)存活，16例死亡（57.1%)；11例因休克死亡；4例心脏破裂因没有手术干扰的时机死亡；1例游离壁破裂因心肌坏死面积过大死于手术台上；还有1例病人在出院7d后死于室颤，在所有无心脏破裂的心源性休克病人中，与接受PTCA和CABG的病人相比，未接受PTCA和CABG的病人的死亡率较高（81.8%vs16.7%)。所有心脏破裂的病人无一存活，死亡率100%。结论 使用IABP对于急性心肌梗死（AMI）所致的心源性休克有显著的效果。但仅使用IABP结合常规治疗而不开通IRA并不能提高这些病人的生存率。心脏破裂的病人若不能及时修补缺损，使用IABP仅能延长病人的存活时间。不能改善病人的生存率。

Use of intra-aortic balloon pump in patients with cardiogenic shock and cardiac rupture caused by acute myocardial infarction

Objective An analysis was made of the death of patients with cardiogenic shock and cardiac rupture treated by intra-aortic balloon pump(IABP).Methods 28 patients were all installed with IABP. 20 patients underwent coronary angiography and 13 patients were treated with PTCA,coronary angioplasty and/or coronary artery bypass grafting (CABG) and cardiac surgery. Results Because of the failure of angioplasty, one patient was successfully submitted to emergency CABG and 11 patients to PTCA of the infarct related artery(IRA).12 patients enjoyed a good outcome.16 patients died (57 1%):11 patients with shock,4 patients with cardiac rupture who hadn't a chance to accept operative intervention, 1 patient with free wall rupture died on table because of massive myocardial necrosis, another patient died of ventricular fibrillation on the 7th day after discharge.The survival of patients with cardiac shock or cardiac rupture was 46 4%.Patients not treated with PTCA,CABG and cardiac surgery had a higher death rate compared with patients treated with PTCA,CABG or cardiac surgery(81 8% vs 16 7%).All patients with cardiac rupture died, and the death rate was 100%.Conclusions Intra-aortic balloon pump was useful for the patients with cardiogenic shock caused by acute myocardial infarction due to severe left ventricular dysfunction.Intra-aortic balloon pump alone did not improve overall survival of the patients with cardiac shock or with a surgically remediable mechanical lesions.