急性心肌梗死伴心源性休克患者PCI治疗中应用主动脉球囊反搏治疗的护理

目的探讨如何提高急性心肌梗死伴心源性休克患者在行冠脉内介入治疗术(PCI)治疗中应用主动脉内球囊反搏治疗的护理配合。方法对5例急性心肌梗死(AMI)伴心源性休克患者在PCI术中应用主动脉内球囊反搏治疗的临床资料进行回顾性分析。结果 5例急性心肌梗死伴心源性休克患者行冠脉内介入治疗术(PCI)治疗中均应用主动脉内球囊反搏治疗,术前熟悉主动脉球囊反搏仪工作原理,主动脉内球囊反搏机(IABP)通过主动脉内球囊与心动周期同步地充放气,舒张期球囊充气,提高平均动脉压,增加冠脉灌注,进而增加氧释放,减轻心肌缺血缺氧;收缩期球囊放气,减少了心脏的后负荷,增加心排血量,降低舒张末期容积及室壁张力,心脏做功减少,从而减少了心肌对氧的需求。故能有效改善心功能,提高心输出量和终末器官灌注。术中密切观察患者生命体征及球囊反搏仪工作状况,加强并发症观察和心理护理,5例患者均顺利结束手术。结论急性心肌梗死伴心源性休克患者PCI治疗中应用主动脉内球囊反搏治疗,由于急性心肌梗死合并心源性休克是危重急症,死亡率极高,在急性心肌梗死合并心源性休克早期应用主动脉内球囊反搏治疗,可改善外周循环和血流动力学,增加心排量,从而防止心源性休克的进一步恶化,如果护理配合工作跟不上,主动脉内球囊反搏治疗不成功,后果很严重,所以,熟练、准确、及时的术中护理配合,对成功救治急性心肌梗死伴心源性休克患者具有重要意义。     

主动脉内气囊反搏在急性心肌梗死合并心源性休克中的效果观察及对心率、收缩压水平影响分析

目的分析主动脉内气囊反搏(IABP)辅助治疗急性心肌梗死并发心源性休克的临床意义。方法本次观测样本选自我院收治的32例急性心肌梗死并发心源性休克患者,入选期为2016年2月至2019年2月。依据不同的治疗手段实施分组,其中对照组直接行经皮冠状动脉介入治疗,观察组行主动脉内气囊反搏联合经皮冠状动脉介入治疗,各16例。对两组患者的血流动力学、心衰实验室指标、心功能指标和心脏相关指标进行分析对比。结果观察组的有创动脉收缩压、有创平均动脉压均高于对照组,肺动脉楔压低于对照组(P0.05);观察组LVEDD、LVEF水平、心脏指数和心率水平改善程度均比对照组良好(P0.05);观察组的Cr、hs-CRP、BNP水平低于对照组(P0.05);观察组的不良事件发生率为12.5%,低于对照组50%(P0.05)。结论主动脉内气囊反搏应用于急性心肌梗死伴有心源性休克中,可改善血流动力学以及心功能,减少患者院内不良事件的发生。     

主动脉内球囊反搏辅助治疗急性心肌梗死合并心源性休克的临床分析

目的分析主动脉内球囊反搏(IABP)辅助治疗急性心肌梗死合并心源性休克的临床疗效。方法选择急性心肌梗死合并心源性休克的老年患者50例,观察置入IABP前后患者血流动力学变化、心功能、IABP并发症及预后情况。结果与IABP置入前比较,患者置入IABP后平均动脉压、心率、LVEF及心功能指标均得到不同程度的改善,无严重并发症出现,预后良好。结论 IABP辅助治疗急性心肌梗死合并心源性休克可能有效安全。     

主动脉内球囊反搏在高危急性心肌梗死直接PCI中的应用

目的探讨合并左心衰竭、心源性休克高危急性心肌梗死(AMI)患者在主动脉内球囊反搏(IABP)支持下行直接PCI的临床疗效。方法88例合并左心衰竭、心源性休克的高危AMI患者,左心衰竭50例,心源性休克38例,在IABP支持下行直接PCI。观察住院期间心脏事件、临床疗效和出院时的左心室射血分数(LVEF)。结果术前安置好IABP,冠状动脉造影示梗死相关血管血流全部TIMI0级。1例心源性休克患者术中因室颤死亡,其余成功实施PCI,手术成功率98.9%,术后81例(93.1%)血流TIMI3级,6例(6.9%)血流TIMI2级。IABP持续使用36￣154(52.6±29.8)h。多支病变者在术后3￣7d再次PCI。住院总生存率70.5%,左心衰竭组80%,心源性休克组57.9%。出院前测平均LVEF40%,左心衰竭组48%,心源性休克组38%。结论合并左心衰竭、心源性休克的高危AMI患者,及时行IABP支持下直接PCI,可明显降低死亡率,改善心脏功能。     

主动脉内气囊反搏在急性心肌梗死并心源性休克患者抢救中的应用

本文对ＡＭＩ并心源性休克患者施行ＩＡＢＰ 9例 ,现报告如下。对象与方法　　 1 对象 :9例ＡＭＩ并泵衰竭 (心源性休克 )患者中 ,男 5例 ,女 4例 ,年龄6 1～ 77岁。急性下壁心梗 3例 ,急性下壁合并右室心梗 1例 ,急性下壁正后壁右室心梗 2例 ,急性前间壁心梗 2例 ,急性前壁心肌梗死 1例。2 方法 :主动脉内气囊反搏机为Ｄａｔａｓｃｏｐｅ 97型 ,采用 35～ 4 0ｍＬ经皮穿刺型气囊导管 ,其方法为经皮穿入股动脉后 ,插入气囊导管 ,根据患者桡动脉压和主动脉压力波形随时调整充气和放气时间。通过Ｓｗａｎ ｃａｎｚ导管用温度稀释法测定心脏指…     

主动脉内气囊反搏支持治疗急性心肌梗死合并心源性休克的护理

目的探讨急性心肌梗死合并心源性休克患者行主动脉内气囊反搏(intra-aortic balloon pump,IABP)支持治疗的术后护理程序和注意事项。方法回顾性分析2007年1月至2008年12月间20例急性心肌梗死合并心源性休克患者行IABP支持治疗的术后护理资料。结果通过精心、系统的护理,急性心肌梗死合并心源性休克患者行IABP支持治疗后均恢复良好,顺利出院。结论落实系统的护理程序,是保证急性心肌梗死合并心源性休克患者行IABP支持治疗后恢复的关键措施和重要手段。     

急性心肌梗死时的心源性休克

急性心肌梗死并发心源性休克的预后不良,住院死亡率高达80％～100％,溶栓治疗不能改善重度泵衰竭和心源性休克患者的预后。早期梗死相关动脉重建和主动脉内气囊反搏术可提高生存率,但必须综合治疗以改善患者的长期预后。     

床边IABP在抢救老年心源性休克患者中的应用

目的观察床边行主动脉球囊反搏在抢救老年心源性休克患者治疗过程中的效果。方法 15例老年心源性休克患者在床边行主动脉球囊反搏,收集IABP治疗前后平均动脉压、尿量、心率、多巴胺的剂量结果进行比较。结果 15例患者IABP治疗前后平均动脉压、尿量、心率、多巴胺的剂量进行配对t检验,差异有统计学意义。结论床边IABP对于老年心源性休克的患者具有确实、有效的治疗作用。能在应用后很快增加冠脉循环的灌注压、提高平均动脉压,改善心肌供血及血流动力学状态。     

主动脉内气囊反搏在急性心肌梗塞病人中的应用

本文报告8例急性心肌梗塞(AMI)并发心源性休克患者应用主动脉内气囊反搏(IABP)进行机械辅助循环的结果;并就AMI患者应用IABP时机,方法及可能产生的并发症进行了讨论。     

主动脉内球囊反搏术治疗急性冠脉综合征伴心源性休克的应用

目的：评价急性冠脉综合征（ACS）合并心源性休克的患者行冠脉介入治疗辅以主动脉内球囊反搏（IABP）术的安全性及有效性。方法：40例ACS合并心源性休克患者,行冠脉介入治疗辅以主动脉内球囊反搏（IABP）术,观察其临床效果及安全性。结果：40例ACS患者经冠脉介入及IABP治疗后,35例存活患者主动脉内收缩压、舒张压显著升高,分别由术前（82．54±5．35）mmHg、（50．34±3．57）mmHg上升至术后（95．11±6．87）mmHg、（80．39±4．86）mmHg（P均〈0．01）。临床症状明显好转,血流动力学显著改善。结论：急性冠脉综合征合并心源性休克患者行冠脉介入治疗时,联合应用主动脉内球囊反搏,可增加冠脉介入治疗安全性,降低病死率,提高手术成功率。     

Percutaneous mechanical cardiac assist in myocardial infarction. Where are we now, where are we going?

Since its first clinical application in patients with cardiogenic shock (CS) in 1968, the intra aortic balloon pump (IABP) increasingly has been used for several clinical conditions requiring mechanical cardiac assistance. In current practice, IABP therapy is still the most accessible and most frequently used method of mechanical cardiac assistance. It is primarily being used as a therapeutic instrument for hemodynamic stabilization in left ventricular failure and cardiogenic shock, mainly in patients with myocardial infarction. Although IABP therapy showed to be effective for stabilization of hemodynamically compromised patients, it has failed to show any long-term survival benefit in any setting of acute myocardial infarction. The rapid developments in ventricular assist device technology have led to the availability of several percutaneous implantable left ventricular assist devices (LVADs). These more potent percutaneous LVADs herald a promising alternative therapeutic approach for mechanical cardiac assistance other than IABP therapy. This article reviews the current status, capabilities, limitations, and future perspectives of currently available percutaneous treatment options for mechanical cardiac assistance in acute myocardial infarction.     

Prescription at discharge of recommended treatments for secondary prevention in patients with ST-segment elevation myocardial infarction according to reperfusion strategies. Results from the IN-ACS outcome study

Since its first clinical application in patients with cardiogenic shock (CS) in 1968, the intra aortic balloon pump (IABP) increasingly has been used for several clinical conditions requiring mechanical cardiac assistance. In current practice, IABP therapy is still the most accessible and most frequently used method of mechanical cardiac assistance. It is primarily being used as a therapeutic instrument for hemodynamic stabilization in left ventricular failure and cardiogenic shock, mainly in patients with myocardial infarction. Although IABP therapy showed to be effective for stabilization of hemodynamically compromised patients, it has failed to show any long‐term survival benefit in any setting of acute myocardial infarction. The rapid developments in ventricular assist device technology have led to the availability of several percutaneous implantable left ventricular assist devices (LVADs). These more potent percutaneous LVADs herald a promising alternative therapeutic approach for mechanical cardiac assistance other than IABP therapy. This article reviews the current status, capabilities, limitations, and future perspectives of currently available percutaneous treatment options for mechanical cardiac assistance in acute myocardial infarction.     

高龄冠状动脉左主干病变合并心源性休克直接PCI治疗2例并文献复习

目的探讨左主干病变导致急性心肌梗死合并心源性休克的高龄（年龄≥75岁）患者在主动脉内球囊反搏（intra-aortic balloon pump,IABP）支持下经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗的可行性。方法回顾性分析2例90岁以上高龄左主干病变合并心源性休克患者在IABP支持下行直接PCI治疗的临床资料并复习相关文献。结果在给予IABP支持下,PCI治疗可恢复灌注以纠正休克,患者血流动力学和神经病学恢复正常,住院期间存活良好。结论在IABP支持下,直接PCI治疗可以拯救高龄患者生命并改善预后,是一种安全有效的临床选择。     

Reperfusionstherapie und mechanische Kreislauf-unterstützung bei Patienten mit kardiogenem Schock

Cardiogenic shock is a state of inadequate tissue perfusion due to cardiac dysfunction, which is most commonly caused by acute myocardial infarction. The pathophysiology of cardiogenic shock is characterized by a downward spiral: ischemia causes myocardial dysfunction, which, in turn, augments the ischemic damage and the energetical imbalance. With conservative therapy, mortality rates for patients with cardiogenic shock are frustratingly high reaching more than 80%. Additional thrombolytic therapy has not been shown to significantly improve survival in such patients. Emergency cardiac catheterization and coronary angioplasty, however, seem to improve the outcome in shock-patients, which most probably is due to rapid and complete revascularization generally reached by angioplasty. In addition to interventional therapy with rapid coronary revascularization, the use of mechanical circulatory support may interrupt the vicious cycle in cardiogenic shock by stabilizing hemodynamics and the metabolic situation. Different cardiac assist devices are available for cardiologists and cardiac surgeons: 1. intraaortic balloon counterpulsation (IABP), 2. implantable turbine-pump (Hemopump), 3. percutaneous cardiopulmonary bypass support (CPS), 4. right heart, left heart, or biventricular assist devices placed by thoracotomy, and 5. intra- and extrathoracic total artificial hearts. Since percutaneous application is possible with IABP, Hemopump and CPS, these devices are currently used in interventional cardiology. The basic goals of the less invasive intraaortic balloon counterpulsation (IABP; Figure 1) are to stabilize circulatory collapse, to increase coronary perfusion and myocardial oxygen supply, and to decrease left ventricular workload and myocardial oxygen demand (Figure 2). Since the advent of percutaneous placement, IABP has been used by an increasing number of institutions (Figure 3). In addition to cardiogenic shock, the system may be of use in a variety of other indications in the catheterization laboratory and intensive care unit, including weaning from percutaneous cardiopulmonary bypass, in ischaemic left ventricular failure, in unstable angina, in high risk PTCA, and in prophylactic support in patients with myocardial infarction and successful revascularization. Animal experimental data showed that IABP may improve success of thrombolysis and recent clinical data suggest that survival is enhanced and transfer for revascularization is facilitated when patients with myocardial infarction and cardiogenic shock undergo thrombolysis and IABP rather than thrombolysis alone. A lot of studies had demonstrated before, that combined use of counterpulsation and revascularization therapy (i.e. coronary bypass surgery or angioplasty) may improve prognosis in patients with myocardial infarction complicated by cardiogenic shock (Table 1). In such patients, early treatment with IABP is most important: Multivariate analysis identified early IABP-support with a duration of shock to IABP-treatment of > or = 4 hours as an independent predictor of a positive short-term outcome. In shock-patients with postinfarction ventricular septal defect, IABP provides a marked hemodynamic improvement, and a significant decrease in shunt-flow (Figure 5). However, despite initial stabilization with IABP, such patients need immediate surgical repair of the septal defect to avoid hemodynamic deterioration. The rate of complications related to percutaneous IABP was significantly attenuated by employing catheters of reduced size. Using 9.5-F catheters, a long duration of counterpulsation emerged as the most significant factor associated with complications. In our hospital, those patients with 9.5-F catheters in whom counterpulsation did not exceed 48 hours had a low complication rate of 3.9%. The Hemopump is a catheter-mounted transvalvular left ventricular assist device intended for surgical placement via the femoral artery (Figures 6 and 7). (ABSTRACT TRUNCATED)     

Intraaortic balloon counterpulsation: an eleven-year review and analysis of determinants of survival

During an 11-year period ending January 1, 1985, 352 patients had insertions of an intraaortic balloon pump (IABP) as an adjunct to medical or surgical therapy. Group I, 175 patients, could not be weaned from cardiopulmonary bypass and required intraaortic balloon pump (IABP). Thirty-nine patients (22%) died in the operating room. Twenty-five patients (14%) died in the acute care unit. The remaining 111 patients (63.4%) survived and were discharged from the hospital. Group II, 104 patients, had the IABP inserted preoperatively. Indications were: postinfarction cardiogenic shock (34 patients), unstable angina (35), postinfarction angina (27), poor ventricular function (six), and prophylaxis (two). Of the 62 patients with unstable angina and postinfarction angina, 57 (92%) were successfully weaned. Of the 34 patients with postinfarction cardiogenic shock, 26 were weaned, but only 16 (47%) survived to leave the hospital. Group III, 34 patients, had the IABP inserted for postoperative hemodynamic deterioration in the acute care unit at variable times: 14 (41%) patients survived. Group IV, 39 patients, had IABP support for medical therapy. Of 24 patients with postinfarction cardiogenic shock, 12 survived. Twelve of 13 patients with unstable angina lived. Of the 352 patients, 228 (65%) were discharged from the hospital. The overall incidence of complications was 12.5%. Complications related to IABP were higher with percutaneous insertion than by femoral arteriotomy (15% vs 12%). Intraaortic balloon counterpulsation effectively unloads the failing left ventricle in weaning patients from cardiopulmonary bypass (Group I). Preoperative insertion (Group II) resulted in 92% survival in patients with both pre- and postinfarction angina. Delayed insertion (Group III) in postoperative patients gave the poorest survival (41%). In patients with postinfarction cardiogenic shock, IABP without corrective cardiac surgery was associated with a 50% survival: with corrective cardiac surgery, 16 patients (47%) survived. Left ventricular dysfunction, myocardial infarction, and timely insertion of IABP are the primary determinants of survival. Approximately one-third of patients who required IABP will die. More involved techniques for mechanical support of the failing circulation, such as ventricular assist device or total artificial heart, may increase survival.     

Circulatory assist devices in cardiology

One out of 13 patients with an acute myocardial infarction is endangered of cardiogenic shock. In addition, acute valvular leakage, shunt vitiae, and acute myocarditis can lead to acute myocardial failure. As a therapeutic option, mechanical assist devices offer cardiac support and hemodynamic stabilization under these circumstances. The following minimal-invasive devices are used in cardiology and intensive care medicine: intra-aortic balloon pulsation (IABP), intra-vascular axial screw pumps, extra-corporal centrifugal pumps with and without additional membrane oxygenator. The IABP improves left ventricular function by a systolic reduction of the after-load, and an increase of diastolic blood pressure dependent on myocardial function. In contrast, axial screw pumps and centrifugal pumps can provide circulatory support independently of myocardial function. Mechanical assist devices can prevent irreversible damage not only by offering a reduction of myocardial work load, but also by improving organ perfusion in cardiogenic shock situations. Another indication for mechanical circulatory support depicts high-risk coronary angioplasty if the left ventricular ejection fraction is severely reduced or the target vessel supplies more than 50 % of vital myocardium. In case of irreversible heart failure, turbine pumps or centrifugal pumps offer a stabilization for the patient's transfer to a cardiac surgery center. They can also be used for bridging to heart transplantation in acute situations. Technical improvements will enhance the use of mechanical assist devices in the near future. Especially the development of portable emergency devices will enrich therapeutic possibilities in cardiology and intensive care medicine.     

Regional and global left ventricular function during intra-aortic balloon counterpulsation in patients with acute myocardial infarction shock

We evaluated the improvement in hemodynamic and left ventricular (LV) function in 15 patients with acute myocardial infarction and cardiogenic shock, who were treated with intraaortic balloon counterpulsation (IABP). They were studied by flow-directed right heart catheterization and nuclear angiography. IABP decreased LV end-diastolic volume from 134 to 114 ml and LV end-systolic volume from 100 to 72 ml. LV stroke volume increased from 34 to 42 ml and cardiac output from 3.0 to 3.6 L/min. Global LV ejection fraction increased from 27.6% to 36.1%, and this was due to improvement in regional ejection fraction in ischemic areas. Pulmonary capillary wedge pressure and pulmonary blood volume decreased. Right ventricular ejection fraction also increased significantly. IABP improved LV function in acute myocardial infarction.     

Intra-aortic balloon counterpulsation

Intra-aortic balloon counterpulsation (IABP) is sometimes used in critically ill patients with cardiac disease. By increasing diastolic arterial pressure and decreasing systolic pressure, it reduces left ventricular afterload. IABP may be beneficial in subjects with cardiogenic shock, mechanical complications of myocardial infarction, intractable ventricular arrhythmias, or advanced heart failure or those who undergo "high-risk" surgical or percutaneous revascularization, but the evidence to support its use in these patient groups is largely observational. Contraindications to IABP include severe peripheral vascular disease as well as aortic regurgitation, dissection, or aneurysm. The potential benefits of IABP must be weighed against its possible complications (bleeding, systemic thromboembolism, limb ischemia, and, rarely, death).     

Effects of intraaortic balloon pumping on acute myocardial infarction in 64 cases of cardiogenic shock, severe heart failure and mechanical heart failure

Of the patients treated in the CCU of Nippon Medical School for acute myocardial infarction in the past 5 years and 8 months, 44 with cardiogenic shock, 11 with severe heart failure, 7 with ventricular septal perforation and 2 with mitral regurgitation were treated by IABP. The peak effect of IABP on the hemodynamics of patients with cardiogenic shock was noted 24 hours after starting on IABP. When hemodynamics were compared between surviving and dead groups, there was a significant difference in stroke volume index between the two groups. When left ventricular function was compared between them, it was suggested that patients whose left ventricular function does not respond to IABP for 48 hours or longer are more likely to die than responders. Twenty-four of 44 patients became independent of IABP, but no more than 13 patients (30%) survived for 6 months or longer. Isosorbide dinitrate (ISDN) was combined with IABP in 7 patients who had a persistence of heart failure in spite of IABP. Combination therapy with IABP and ISDN elicited a significant increase in cardiac index, a significant decrease in pulmonary capillary wedge pressure, mean pulmonary arterial pressure and total peripheral resistance and a pronounced improvement in left ventricular function, and all 7 patients became independent of IABP. In the patients with acute myocardial infarction complicated with ventricular septal perforation, the mean systolic arterial pressure was 87.7 +/- 8.3 mmHg, mean pulmonary capillary wedge pressure, 20.3 +/- 7.4 mmHg and pulmonary-to-systemic flow ratio, 3.12 +/- 0.95 before starting on IABP. When the hemodynamics at 3 hours of IABP were compared to the pre-IABP values, the right atrial pressure, pulmonary capillary wedge pressure and pulmonary-to-systemic flow ratio had a tendency to decline, but the changes were not statistically significant, except for the peak arterial pressure which showed a significant elevation at 3 hours of IABP. Three of the 7 patients became dependent on IABP, and 2 of the 3 patients were saved by emergency operation.