主动脉内球囊反搏在高危急性心肌梗死患者中的应用

目的 探讨主动脉内球囊反搏(IABP)在急性心肌梗死患者中的应用时机和对预后的影响.方法 连续观察入选的急性心肌梗死患者1206例.前壁梗死464例,下壁梗死(包括后、右室梗死)474例,非ST段抬高心肌梗死268例.成功再灌注者505例,药物保守治疗701例.心源性休克患者89例.合并心源性休克、左主干或三支血管病变、经皮冠状动脉介入(PCI)术中出现肺水肿、室性心律失常、合并室间隔穿孔或乳头肌功能不全等情况时应用IABP辅助治疗.将IABP放置时机分为2组,置入IABP时血流动力学稳定或心源性休克发生1 h内为早置组,置入IABP时血流动力学不稳定或心源性休克发生1 h后为晚置组.结果 ①IABP置入者97例,心源性休克者占45.3%(44/97),左主干或三支病变PCI者占21.7%(21/97),血流动力学不稳定者占15.5%(15/97).平均应用IABP时间3.8 d.②置入IABP患者中,死亡组成功再灌注率低于存活组45.7%(16/35)比66.1%(41/62),P=0.041],IABP早置入率死亡组低于存活组25.7%(9/35)比91.9%(57/62),P=0.000],死亡组合并心源性休克82.9%(29/35)比24.2%(15/62),P=0.000]、心脏破裂20%(7/35)比0(0/62);P=0.000]、入院时BUN(8.8±2.4)mmol/L比(6.3±1.0)mmoL/L,P=0.040]和Cr(132.6±35.4)βmoL/L比(79.6±17.7)βmol/L,P=0.000]明显高于存活组.③Logistic回归分析显示:心源性休克(OR=0.066,CI 0.018～0.241,P=0.000)和IABP置入时机(OR=0.219,CI 0.062～0.778,P=0.019)是死亡的独立危险因素.结论 高危AMI患者尽早应用IABP可明显降低住院病死率.

Application of intra-aortic balloon counterpulsation in patients with acute myocardial infarction

Objective To observe the application of intra-aortic balloon counterpulsation(IABP)in patients with acute myocardial infarction(AMI).Methods 1206 eases of AMI were selected consecutively.505 cases received successful reperfusion therapy and 701 cases received medical conservative therapy.464 cases were with anterior infarction,474 cases with inferior/posterior infarction and 268 cases with non-ST elevated MI(NSTEMI).There were 89 cases with cardiogenic shock(CS).Intra-aortic balloon pump(IABP)was used in patients accompanied with CS.cardiac rupture or papillary muscle dysfunction,left main or three vessel lesions with hemodynamic stability,pulmonary edema or ventficular arrhythmia in the course of PCI.Patients with IABP were divided into two groups according to juncture of IABP,early group(IABP was used in hemodynamic stability or within 1 hour of CS)and late group(IABP was used in hemodynamic instability or after 1 hour of CS).Results ①IABP was used in 97 patients.CS accounted for 45.3%(44/97),high risk PCI took 21.7%(21/97),hemodynamic instability was 15.5%(15/97).Mean duration of IABP insertion was 3.8 days.②In patients with IABP,successful reperfusion of death group45.7%(16/35)vs 66.1%(41/62),P=0.041]and early IABP insertion group25.7%(9/35)vs 91.9%(57/62),P=0.000]were fewer than that of survival.Accompanied with Cs82.9%(29/35)vs 24.2%(15/62),P=0.000],cardiac rupture20%(7/35)vs 0(0/62),P=0.000],urea nitrogen(8.8±2.4)mmol/Lvs(6.3±1.0)mmol/L,P=0.040]and creatinine(132.6±35.4)umol/L vs(79.6±17.7)μmol/L,P=0.000)]of death group were higher than that of survival.③Logistic regression analysis showed that CS(OR=0.066,CI 0.018-0.241,P=0.000)and juncture of using IABP(OR=0.219,CI 0.062-0.778,P=0.019)were the independent risk factors for death.Conclusion Using IABP earlier in high risk patients with AMI may reduce in-hospital mortality.