主动脉内球囊反搏在急性心肌梗死合并心源性休克治疗中的应用

目的评价主动脉球囊反搏术(IABP)在急性心肌梗死(AMI)合并心源性休克治疗中的应用价值。方法选取AMI合并心源性休克患者65例,其中IABP组30例,在IABP支持下行急诊经皮冠状动脉介入治疗(PCI),对照组35例,单纯行急诊PCI治疗。结果IABP组患者在IABP支持下,30 min后血流动力学指标改善,2~8 h血流动力学稳定,均完成梗死相关血管再通,没有血管再闭塞事件发生,无术中死亡,院内死亡率40%;对照组患者院内死亡率74.3%,其中6例在术中死亡。结论IABP可明显改善AMI合并心源性休克患者的血流动力学指标,增加冠状动脉的灌注;IABP可提高急诊PCI的成功率,减少术后低心排综合征及血管再闭塞事件的发生,降低院内死亡率,明显改善了AMI合并心源性休克患者的预后。     

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。     

高龄急性心肌梗死合并泵功能衰竭患者主动脉内气囊反搏术辅助介入治疗的研究

目的探讨急性心肌梗死（AMI）合并泵功能衰竭的高龄患者行急诊冠脉介入治疗辅以主动脉内气囊反搏术（IABP）的安全性及有效性。方法62例高龄AMI并发泵功能衰竭患者分为IABP组（28例）及对照组（34例），IABP组在IABP支持下行急诊冠状动脉造影，对梗死相关血管（IRA）直接行PTCA及支架置入术，对照组单纯行PTCA及支架置入术，治疗前及3个月后行心脏超声检查及心功能测定。结果两组心功能较术前均明显改善，但IABP组较对照组改善更加明显。IABP组完成梗死相关血管再通，没有血管再闭塞事件发生。无术中死亡，院内死亡率28．6％；对照组患者院内死亡率64．7％，其中4例发生血管再闭塞事件，8例术中死亡。结论AMI合并泵功能衰竭高龄患者行急诊冠脉介入治疗时，联合应用主动脉内气囊反搏可增加冠脉介入治疗安全性。降低病死率，减少血管再闭塞率，提高手术成功率。     

急诊PCI和主动脉球囊反搏治疗AMI合并心源性休克的临床疗效

目的　观察急性心肌梗死(AMI)合并心源性休克行急诊经皮冠状动脉介入治疗(PCI)和主动脉球囊反搏(IABP)患者的疗效及对心功能的影响。方法　6例诊断AMI合并心源性休克患者行急诊PCI及IABP辅助治疗,术后4周内进行心脏彩超检查,评估梗死区的心肌收缩功能和左室射血分数。结果　6例患者中6支梗死相关动脉全部再通,共植入支架8枚。无致命性并发症出现(急性心肌梗死、急诊冠脉旁路移植术及术中死亡等)。IABP维持时间4～1 3d,平均(6. 7±1 . 2 )d,术后心脏彩超检查6例患者都有心肌节段性运动异常,1例心尖区室壁瘤形成,左室射血分数为0 .47±0 . 1 1 (0 . 3 5～0 . 5 8)。随访3个月,无死亡、靶病变血管重建治疗、血栓形成或心肌梗死。结论　急性心肌梗死合并心源性休克的患者行急诊PCI及IABP治疗,在短时间内改善心源性休克的血流动力学异常,能有效地恢复梗死区心肌早期再灌注,缩小梗死面积,降低死亡率。     

主动脉球囊反搏术在急性心肌梗死并心源性休克行冠状动脉支架植入术中的临床评价

目的评价主动脉内球囊反搏术(IABP)在急性心肌梗死(AMI)并心源性休克(CS)行经皮冠状动脉介入治疗(PCI)中的疗效。方法 AMI并CS的100例患者一经确诊即予急诊IABP循环支持治疗,以同时期同一疾病未经IABP治疗的100者作为对照组进行比较,两组均在常规用药基础上行PCI治疗。观察两组患者IABP前后的心功能指标、PCI术后1周内死亡率及血管再闭塞事件发生率。结果治疗组进行IABP后桡动脉内测舒张压、MAP、CI、CO、SV、EF较术前明显升高(P<0.05或P<0.01),而PCWP较术前明显降低(P<0.05),治疗组死亡率显著低于对照组(P<0.05),治疗组血管再闭塞事件发生率显著低于对照组(P<0.05)。结论 IABP可显著改善心功能,降低AMI并CS患者的死亡率,减少血管再闭塞率。     

急诊经皮冠状动脉介入治疗联合主动脉内球囊反搏的临床疗效分析

目的 对急诊经皮冠状动脉介入治疗(PCI)围术期合并心源性休克(CS)患者联合主动脉内球囊反搏(IABP)辅助支持治疗进行临床观察,分析评估与其住院病死率相关的危险因素.方法 58例急性心肌梗死(AMI)患者行急诊冠状动脉(冠脉)造影和(或)PCI,全部病例围术期因合并心源性休克行不同时期的IABP辅助支持,并对其中54例(93.1%)梗死相关动脉(IRA)植入冠脉支架(64枚).回顾性分析患者的临床特征,冠脉造影,PCI治疗情况和住院期疗效.结果 58例患者平均住院12.3天±9.7天,住院期间39例(64.24%)存活(存活组),19例(32.76%)死亡(死亡组).与存活组比较,死亡组患者年龄增大,左主干和三支血管病变增多,术后IRA血流TIMI 0-1级发生率增高(P＜0.05).结论 IABP为急诊PCI围术期合并心源性休克的AMI患者提供稳定的血流动力学支持,高龄、左主干病变、三支血管病变和IRA未充分开通是住院期病死率的主要危险因素.     

冠状动脉内注射替罗非班对老年糖尿病急性心肌梗死患者的影响

目的探讨冠状动脉内注射替罗非班对老年糖尿病合并急性心肌梗死(AMI)患者急诊PCI的近期疗效和安全性。方法选择急诊PCI的老年糖尿病合并AMI患者97例,随机分为对照组(A组)49例、替罗非班组(B组)48例;另选择同期急诊PCI给予替罗非班治疗的非老年糖尿病合并AMI患者(C组)129例。对3组冠状动脉病变特征、并发症发生率等进行比较。结果与A组比较,B组和C组PCI术后TIMI 3级血流、心肌灌注3级明显升高(P<0.01),心肌灌注0～1级、2级、平均住院天数、梗死后心绞痛、恶性心律失常发生率明显降低(P<0.05,P<0.01)。3组单支、双支和3支病变、入院到球囊扩张平均时间、住院期间再梗死、支架内血栓、心源性休克发生率和30d病死率等无明显变化(P>0.05)。结论替罗非班能有效改善老年糖尿病合并AMI患者的TIMI血流和心肌灌注分级,降低梗死后心绞痛、恶性心律失常等并发症的发生。并不增加严重出血并发症。     

急性心肌梗死急诊经皮冠状动脉介入治疗患者院内死亡因素分析

目的:分析急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)手术住院期间死亡的危险因素及死亡原因。方法:438例接受急诊PCI的AMI患者,根据住院期间存活与否,分为死亡组(21例)和存活组(417例),比较两组患者的临床特征和冠状动脉造影及介入治疗结果,分析发生院内死亡的原因及死亡预测因素。结果:死亡组患者中年龄65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、多支闭塞(≥2支)、近段闭塞、梗死相关动脉(IRA)开通后即刻TIMI血流≤Ⅱ级、IRA开通后即刻血压下降与存活组相比较差异有统计学意义(均P0.05)。多因素logistic回归分析表明年龄65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、IRA开通后即刻TIMI血流≤Ⅱ级是急诊PCI患者围术期死亡的独立预测因素。死亡原因中,心源性休克8例(38.1%)、恶性心律失常6例(28.6%)分居第1和第2位。结论:年龄65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、IRA开通后即刻TIMI血流≤Ⅱ级是急诊PCI患者围术期死亡的危险因素。心源性休克、恶性心律失常是急诊PCI手术住院期间主要死亡原因。     

急性心肌梗死合并心源性休克的经皮冠状动脉介入治疗及主动脉球囊反搏治疗疗效

目的　观察急性心肌梗死 (AMI)合并心源性休克时在主动脉球囊反搏 (IABP)支持下行经皮冠状动脉成形术 (PTCA)及冠状动脉内支架置入术对患者早期死亡率及心功能的影响。方法　于发病 0 5～ 32h内在IABP支持下行急诊冠状动脉造影 ,对梗死相关血管 (IRA)直接行PTCA及支架置入。 5周内行心脏超声检查及心功能测定。结果　除 4例在行IABP 1h内心衰及休克加重而死亡外 ,余 2 8例患者IRA全部再通 ,置入支架 2 4例 ,成功率 85 71% ,发病至血管再通时间平均 8 6h ,死亡率为 31 2 5 %。 2 2例存活患者 5周内检查射血分数 (EF)为 0 4 3～ 0 6 7。结论　应用IABP作为辅助手段对提高休克病人PCI再灌注非常重要 ;可降低死亡率 ,改善术后近期心功能。     

急性心肌梗死伴心源性休克患者PCI术后应用主动脉内球囊反搏治疗的护理

急性心肌梗死(AMI)合并心源性休克是危重急症,死亡率极高[1],临床使用急诊冠脉内介入治疗,并随即进行主动脉内球囊反搏(IABP)以改善心肌供血、供氧,减轻心脏负担,改善左室功能,改善心脏作功,同时增加冠状动脉血灌注和减少心肌耗氧[2].2004年1月至2005年11月,本院心内科对8例急性心肌梗死伴心源性休克行急诊PCI手术的患者使用了IABP治疗,收到了满意的疗效,现将护理进行总结.     

急性心肌梗死合并心原性休克47例治疗和死亡原因分析

目的 评价急性心肌梗死合并心原性休克47例患者的临床疗效,寻求降低病死率、改善预后的措施.方法 回顾性分析2002年1月至2007年5月共47例心肌梗死合并心原性休克患者,运用心血管活性药物、主动脉内球囊反搏(IABP)、介入手术或冠状动脉旁路移植术的治疗效果.结果 IABP治疗47例(100%),再血管化治疗41例(87.3%),死亡17例(36.2%).经药物和IABP治疗,在接受再血管化前死亡的患者占死亡数的35.3%(6/17),再血管化后死亡的患者占死亡数的64.7%(11/17).死于心功能衰竭者9例,死于肾功能衰竭和呼吸功能衰竭者8例.11例出现急性肾功能衰竭的患者全部死亡.急性肾功能衰竭(r=0.734,P=0.000)、急性呼吸功能衰竭(r=0.606,P=0.000)和糖尿病(r=0.372,P=0.012)与死亡有相关关系.结论 尽管急性心肌梗死合并心原性休克的治疗有了很大的发展,但病死率仍然较高,主要死因是急性心力衰竭、急性肾功能衰竭和急性呼吸功能衰竭.要进一步降低急性心肌梗死合并心原性休克患者住院病死率,可能需要更好的循环辅助装置及加强重要器官的保护.     

Appropriate indications for the use of a percutaneous cardiopulmonary support system in cases with cardiogenic shock complicating acute myocardial infarction

Percutaneous cardiopulmonary support (PCPS) is now available for hemodynamic support in patients with cardiogenic shock, but there are no guidelines for its use. The present study determined the appropriate indications for the use of the PCPS in patients with cardiogenic shock complicating acute myocardial infarction (AMI). Sixty-four consecutive patients with cardiogenic shock complicating AMI had hemodynamic support with an intraaortic balloon pump (IABP; n=38) and/or PCPS (n=26). The shock score (0-15) was calculated immediately before starting these support systems to quantify the severity of shock. Multivariate logistic regression analysis determined the clinical factors affecting in-hospital mortality. The relationship between in-hospital prognosis and the shock score was also examined in the 2 groups. The most significant factor related to the in-hospital prognosis was the shock score (p=0.0007; OR 2.16, 95% CI: 1.37-3.39). Another related factor was revascularization; however, this relationship did not reach statistical significance (p=0.069; OR 0.06). Among the 13 cases whose shock score was 4-8 (moderate shock), 5 survived in the PCPS group, but only 1 of 19 patients survived in the IABP group (p<0.05). None of the patients in either group whose shock score was more than 9 survived. The severity of shock is the most reliable independent predictor of in-hospital mortality in patients with cardiogenic shock complicating AMI. Using PCPS in patients with moderate cardiogenic shock may improve their in-hospital survival, but it must be used before the shock becomes severe.     

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。     

主动脉球囊反搏术对急性心肌梗死并发心源性休克患者冠状动脉介入术后C反应蛋白水平的影响

目的:评价急性心肌梗死(AMI) 并发心源性休克患者行急诊介入治疗(PCI)时主动脉球囊反搏术(IABP)对术后C反应蛋白(CRP)水平的影响.方法:43例在IABP支持下行急诊PCI的并发心源性休克的AMI患者为IABP组,将同期行急诊PCI但没有行IABP支持的合并心源性休克的AMI患者48例设为对照组;入院后分别测定入院时以及第3天、第7天的CRP水平;比较2组PCI术后TnI峰值,术后2周、3个月的左室射血分数,随访患者术后3个月的病死率.结果:2组患者入院时的CRP水平无明显差异,而第3天、第7天的CRP水平IABP组明显低于对照组[(80.3±42.8):(98.9±31.6) mg/L , (70.6±34.3):(85.8±25.8 )mg/L;均P<0.05];IABP组患者术后TNI峰值明显低于对照组[(21.6±4.1):(23.7±4.6)ng/ml, P<0.05],术后2周、3个月的左室射血分数较对照组明显改善[(44.7±7.3)%:(40.5±6.2)%,( 45.1±6.6)%:(40.7±4.4)%;均P<0.05];而IABP组术后3个月内的病死率明显降低(P<0.05).结论:对并发心源性休克的AMI患者行急诊PCI术同时采用IABP支持治疗能明显降低术后CRP水平,并能有效地改善左室功能和降低术后3个月内病死率.     

Möglichkeiten und Grenzen der interventionellen Therapie bei akuter Herzinsuffizienz bei koronarer Herzerkrankung

Acute heart failure and especially its most severe form, cardiogenic shock, remain the final common pathway to death in a substantial number of patients with acute myocardial infarction (MI). Several studies demonstrated that mechanical reperfusion of occluded coronary arteries by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery improves survival in patients with acute MI and cardiogenic shock. There is strong evidence that intraaortic balloon pump (IABP) support and ventricular assist devices can stabilize hemodynamics in these patients so that revascularization procedures can be safely performed. This article provides an overview of the therapeutic strategies for acute MI with cardiogenic shock, with focus on the role and particularities of different devices used as mechanical circulatory support in these patients.     

急诊PCI联合主动脉内球囊反搏对急性心肌梗死合并心源性休克的疗效

目的：探讨经皮冠状动脉介入治疗（PCI）联合主动脉球囊反搏术（IABP）治疗急性心肌梗死（AMI）心源性休克患者的临床疗效。方法：回顾性分析16例联合IABP行PCI治疗的AMI合并心源性休克患者的临床资料。结果：16例患者均成功置入IABP及行PCI术,IABP使用时间20～190（70.6±37.2）h,3例（18.75%）出现局部穿刺部位出血,经压迫后出血停止,除住院期间死亡1例（6.25%）,无重大并发症。结论：对于心源性休克患者,联合主动脉球囊反搏术行经皮冠状动脉介入治疗安全、有效。     

The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2

BACKGROUND: Cardiogenic shock complicating acute myocardial infarction (AMI) remains the leading cause of death in patients hospitalized with AMI. Although several studies have demonstrated the importance of establishing and maintaining a patent infarct-related artery, it remains unclear as to whether intra-aortic balloon counterpulsation (IABP) provides incremental benefit to reperfusion therapy. The purpose of this study was to determine whether IABP use is associated with lower in-hospital mortality rates in patients with AMI complicated by cardiogenic shock in a large AMI registry. METHODS: We evaluated patients participating in the National Registry of Myocardial Infarction 2 who had cardiogenic shock at initial examination or in whom cardiogenic shock developed during hospitalization (n = 23,180). RESULTS: The mean age of patients in the study was 72 years, 54% were men, and the majority were white. The overall mortality rate in all patients who had cardiogenic shock or in whom cardiogenic shock developed was 70%. IABP was used in 7268 (31%) patients. IABP use was associated with a significant reduction in mortality rates in patients who received thrombolytic therapy (67% vs 49%) but was not associated with any benefit in patients treated with primary angioplasty (45% vs 47%). In a multivariate model, the use of IABP in conjunction with thrombolytic therapy decreased the odds of death by 18% (odds ratio, 0.82; 95% confidence interval, 0.72 to 0.93). CONCLUSIONS: Patients with AMI complicated by cardiogenic shock may have substantial benefit from IABP when used in combination with thrombolytic therapy.     

高危复杂冠脉病变经皮冠状动脉介入术前保护性置入主动脉内球囊反搏的临床观察

目的:探讨高危复杂冠脉病变患者经皮冠状动脉介入术(PCI)前保护性置入主动脉内球囊反搏(IABP)对围手术期临床疗效的影响。方法:回顾性分析高危复杂冠脉病变的患者190例,其中PCI术前保护性置入IABP的79例为观察组,其余111例没有预先置入IABP或术中病情变化紧急被动置入IABP的患者为对照组。比较2组术中、术后及临床转归情况。结果:观察组中仅1例患者术后IABP持续携带3 d拔除,其余均术后即刻拔除;观察组患者均能耐受手术,术后无急性、亚急性血栓,无心力衰竭发生,无1例死亡。观察组入路并发症的发生率以及血红蛋白下降水平明显高于对照组(均P0.05)。对照组有3例术中突发急性左心衰,1例发生冠脉严重无复流,从而被动置入IABP,此3例患者中1例因心原性休克抢救无效死亡,2例IABP持续携带5 d后拔除。结论:高危复杂冠脉病变介入治疗中,保护性预置入IABP能明显提高患者的手术耐受性和手术成功率,减少PCI术中并发症,降低围手术期不良事件。     

Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction: the benchmark registry

OBJECTIVES: We sought to examine contemporary utilization patterns and clinical outcomes in patients with acute myocardial infarction (AMI) requiring intra-aortic balloon pump (IABP) counterpulsation. BACKGROUND: Despite increasing experience with and broadened indications for intra-aortic counterpulsation, the current indications, associated complications, and clinical outcomes of IABP use in AMI are unknown. METHODS: Between June 1996 and August 2001, data were prospectively collected from 22,663 consecutive patients treated with aortic counterpulsation at 250 medical centers worldwide; 5,495 of these patients had AMI. RESULTS: Placement of an IABP in AMI patients was most frequently indicated for cardiogenic shock (27.3%), hemodynamic support during catheterization and/or angioplasty (27.2%) or prior to high-risk surgery (11.2%), mechanical complications of AMI (11.7%), and refractory post-myocardial infarction unstable angina (10.0%). Balloon insertions were successful in 97.7% of patients. Diagnostic catheterization was performed in 96% of patients, and 83% underwent coronary revascularization before hospital discharge. The in-hospital mortality rate was 20.0% (38.7% in patients with shock) and varied markedly by indication and use of revascularization procedures. Major IABP complications occurred in only 2.7% of patients, despite median use for three days, and early IABP discontinuation was required in only 2.1% of patients. CONCLUSIONS: With contemporary advances in device technology, insertion technique, and operator experience, IABP counterpulsation may be successfully employed for a wide variety of conditions in the AMI setting, providing significant hemodynamic support with rare major complications in a high-risk patient population.