急性心肌梗死伴心源性休克患者应用主动脉内球囊反搏治疗的临床观察

目的：探讨急性心肌梗死（ANI）伴心源性休克患者应用主动脉内球囊反博（IABP）治疗的临床疗效。方法：选取20例急性心肌梗死伴心源性休克患者的临床资料,并进行回顾性分析。所有患者采用主动脉内球囊反博治疗,记录其治疗前后的心脏指数、心率及平均动脉压,分析临床治疗效果。结果：经主动脉内球囊反博治疗4 h后,患者血流动力学明显改善,其中痊愈13例（占65%）,自动出院3例（占15%）,死亡4例（占20%）。结论：采用主动脉内球囊反博治疗急性心肌梗死伴心源性休克可有效改善患者血流动力学,对提高生存率具有重要意义,值得临床推广应用。     

急性心肌梗死合并心源性休克患者行主动脉球囊反搏术的护理观察

目的探讨以主动脉球囊反搏术治疗急性心肌梗死合并心源性休克患者后的护理方法和成效。方法选择2014年9月1日~2015年10月30日行主动脉球囊反搏术治疗急性心肌梗死合并心源性休克的患者23例为研究对象,对其护理过程进行回顾性分析。结果在对以上患者实施脉球囊反搏护理、心理护理、并发症护理及其生命体征监测之后,所有患者均生命体征平稳、循环稳定,并好转出院,未发生死亡。结论行主动脉球囊反搏术治疗急性心肌梗死合并心源性休克患者后必须对其加强全面的护理干预,以此促进患者的治疗。     

体外膜肺氧合联合主动脉内球囊反搏治疗急性心肌梗死的护理

目的讨论急性心肌梗死合并心源性休克患者联合应用体外膜肺氧合与主动脉内球囊反搏的护理。方法急性心肌梗死合并心源性休克患者2例,经一侧股动脉、静脉插管行心肺辅助,采用动脉-静脉模式进行体外膜肺氧合,经另一侧股动脉进行主动脉内球囊反搏,并采用一系列针对性的护理措施。结果 2例患者在使用体外膜肺氧合与主动脉内球囊反搏后,循环逐渐稳定,顺利撤机,好转出院。结论在体外膜肺氧合与主动脉内球囊反搏联合治疗中,优质护理在预防和及时发现、处理并发症等方面起着关键作用。     

老年急性心肌梗死合并泵衰竭不同治疗方法的疗效分析

急性心肌梗死的住院患者大约有5%～8%合并心源性休克,其死亡率达80%～100%。经皮冠状动脉介入治疗是急性心肌梗死积极有效的治疗措施,可明显降低急性心肌梗死的死亡率。冠脉介入同时接受主动脉内球囊反搏术(IABP)治疗,是近年来日益广泛应用于急性心肌梗死合并泵衰竭的治疗技术,同时也不断有临床试验证实在治疗中有显著的优势[1-3]。本研究将急性心肌梗死合并严重泵功能衰竭患者接受IABP治疗与未行IABP治疗患者进行比较,探讨不同治疗方法和疗效,指导临床选择最佳治疗方案。1资料方法1.1病例选择入选标准:(1)典型的缺血性胸痛30分钟以上…     

主动脉球囊反搏及联合机械通气治疗心源性休克的比较

目的比较主动脉球囊反搏(IABP)与IABP联合机械通气治疗急性心肌梗死合并心源性休克的临床疗效,探讨更有效的治疗方法。方法回顾性分析2005年1月~2013年12月共71例心肌梗死合并心源性休克患者,药物治疗效果不佳,38例应用IABP(IABP组),33例应用IABP联合机械通气(IABP+MV组),比较两组间基线资料、临床指标、并发症等的差异,并分析影响院内死亡的因素。结果 IABP+MV组左心室射血分数(LVEF)由治疗前的(36.4±5.2)%增加至治疗后的(43.8±5.3)%(t=5.761,P=0.000),IABP组由治疗前的(41.7±4.5)%增加至治疗后的(44.0±4.9)%(t=2.103,P=0.039),可见IABP+MV组比IABP组增加更显著(t=3.806,P=0.000)。IABP+MV组肺部感染(χ2=4.283,P=0.038)及肾功能不全(χ2=3.997,P=0.046)发生率明显高于IABP组,肺部感染、肾功能不全与院内死亡的危险性呈正相关,为阳性预测因子;成功血运重建与院内死亡危险呈负相关,为阴性预测因子。结论 IABP联合机械通气,有益于心源性休克患者心功能改善,但并不能降低院内死亡率,降低院内死亡率主要依赖于成功血运重建。IABP联合机械通气可能会增加肺部感染和肾功能不全的发生率,二者也是影响心源性休克患者院内死亡的主要危险因素。     

主动脉内囊反搏术辅助经皮冠状动脉介入治疗急性心肌梗死并心源性休克24例临床观察

对24例急性心肌梗死并心源性休克患者行经皮冠状动脉介入治疗，辅助行主动脉内囊反搏术，观察治疗前后患者血流动力学各项指标及心功能的变化。结果显示24例IABP患者死亡6例，存活者治疗前后血流动力学各项指标及左室收缩功能比较有显著性差异（P〈0．01）。认为主动脉内囊反搏与经皮冠动脉个入结合治疗急性心肌梗死并心源性休克可以显著改善心功能及降低死亡率。     

急性心肌梗死患者行冠状动脉旁路移植术（CABG）围手术期行主动脉内球囊反搏辅助治疗的临床分析

目的总结急性心肌梗死患者行CABG术围手术期应用主动脉内球囊反搏辅助治疗的临床经验,探讨主动脉内球囊反搏对急性心肌梗死患者预后影响。方法总结2012年1月—2013年1月在青岛市市立医院22例急性心肌梗死行CABG手术围手术期应用主动脉内球囊反搏的患者资料进行临床分析结果 22例患者死亡1例,其余均康复出院。结论对高危CABG患者预防性应用IABP能够降低围术期病死率,改善患者预后。     

主动脉内球囊反搏在冠心病泵衰竭中的应用

目的探讨主动脉内球囊反搏在冠心病泵衰竭中的应用效果。方法回顾性分析我院30例冠心病并泵衰竭患者的临床资料,该组患者均采用主动脉内球囊反搏治疗,比较两组患者治疗前后的血压、心脏指数的变化,并总结患者的并发症和死亡率。结果经主动脉内球囊反搏治疗30min后,该组患者的舒张期反搏压达到65-130mmHg。心脏指数和平均动脉压均较治疗前有了显著性提高(P<0.05),临床症状显著缓解。因不可逆的心源性休克,伴随严重疾病及治疗时机过晚,死亡5例,死亡率为16.7%。3例患者出现并发症。结论主动脉内球囊反搏治疗冠心病泵衰竭疗效较好,其可显著增加冠状动脉血流、减轻心脏后负荷,但决定患者预后的关键是适应证的选择。     

女性ST段抬高型急性心肌梗死患者行冠状动脉介入治疗的临床特点分析

目的:探讨冠状动脉介入治疗在不同性别STEMI患者的临床实际效果,总结不同性别人群的特点。方法:选取女性急性ST段抬高型心肌梗死患者80例并采用整群抽样的方法选择80例男性患者作为对照,分析男性与女性STEMI行急诊PCI患者的临床治疗的近远期疗效。结果:女性组的发病年龄和高血压、糖尿病比例显著高于男性组(P0.05),两组PCI的成功率及术中心律失常、心源性休克发生率和主动脉内球囊反搏术(IABP)应用比例相似,女性组住院期心源性死亡率显著高于男性组,1年临床随访结果显示女性组心源性死亡、急性心肌梗死和主要不良心脏事件发生率高于男性。结论:与男性相比,女性急性ST段抬高型心肌梗死患者年龄较高,合并危险因素比例多,女性组住院期和随访期心源性死亡率高于男性,两者有统计学差别。     

主动脉球囊反搏术后监护

急性心肌梗死病人心源性休克的发生率约为5%~10%,其死亡率高达80%~100%,而主动脉内球囊反搏(in-tra-aortic balloon pulsa-tion,IABP)是再灌注治疗的重要辅助手段,通过动脉系统植入一根球囊导管到降主动脉内左锁骨下动脉开口远端,使主动脉内球囊充气和放气,通过舒张期主动脉压升高,降低左心室阻抗,减少心脏耗氧和做功,起到辅助循环的效果。我院CCU于2002年1月至2005年12月应用IABP9例,效果满意,现将术后监护报告如下。1临床资料1.1一般资料本组9例病人中,男6例,女3例,年龄27~74岁,平均年龄50.5岁,其中急性心肌梗死合并心源性休克急行I…     

主动脉内球囊反搏在心脏术后心源性休克中的应用

[目的]对应用主动脉内球囊反搏(IABP)治疗心脏术后心源性休克的疗效进行评估。[方法]对l3例心脏手术后并发心源性休克及低心排血量综合征的患者,应用IABP治疗。其中,单纯冠状动脉搭桥术9例,二尖瓣替换加冠状动脉搭桥术2例,再次行主动脉瓣替换术l例,再次行二尖瓣替换加三尖瓣替换术l例。[结果]9例患者心功能得到明显改善,度过围术期,顺利脱离IABP,成功率为69.2%(9/13)。[结论]IABP是心脏术后心源性体克的有效手段,能明显降低病死率。     

Management of cardiogenic shock complicating acute myocardial infarction: The Henry Ford Hospital experience and review of the literature.

Cardiogenic shock complicating acute myocardial infarction (MI) carries a high mortality which in some series prior to 1980 exceeded 80%. Neither the use of inotropic and vasopressor agents nor intraaortic balloon counterpulsation was found to improve survival in this group of patients. Intravenous thrombolytic agents improve survival in patients with acute MI, but their role in cardiogenic shock is unknown. Reports of the use of surgical and mechanical interventions in patients with severe left ventricular dysfunction were examined to determine if there was any benefit to be derived from restoring blood flow to ischemic areas of the myocardium. It was found that urgent placement of intraaortic balloon counterpulsation followed by coronary bypass surgery may improve survival rates and successful coronary angioplasty also appeared to benefit patients with cardiogenic shock. Similar improvement in survival has been reported after successful coronary reperfusion. In surgical series with predominantly nonmechanical causes of shock, survival has varied from 40% to 88%. Data from our five-year experience in the management of MI patients with cardiogenic shock suggest that coronary revascularization with coronary angioplasty or bypass surgery improves survival in patients with cardiogenic shock especially when performed within 24 hours of the onset of shock.     

主动脉内气囊反搏术治疗急性心肌梗死心源性休克疗效分析

目的观察主动脉内球囊反搏术(IABP)辅助治疗急性心肌梗死(AMI)并心源性休克的效果。方法分析16例AM I并心源性休克患者应用IABP后的治疗效果。结果16例接受IABP治疗后,血流动力学稳定,其中的10例接受再血管化治疗,存活11例,死亡5例,存活率为68.8%。结论IABP可有效稳定血流动力学状态,提高了生存率,是有效的辅助治疗手段。     

主动脉内气囊反搏术治疗急性心肌梗死心源性休克疗效分析

目的观察主动脉内球囊反搏术（IABP）辅助治疗急性心肌梗死（AMI）并心源性休克的效果。方法分析16例AMI并心源性休克患者应用IABP后的治疗效果。结果16例接受IABP治疗后，血流动力学稳定，其中的10例接受再血管化治疗，存活11例，死亡5例，存活率为68．8％。结论IABP可有效稳定血流动力学状态，提高了生存率，是有效的辅助治疗手段。     

Intra-aortic balloon pump counterpulsation: are we optimizing the management of cardiogenic shock?

Intra-aortic balloon pump counterpulsation (IABPC) has been used in various forms for decades. The change in physiology brought about by their use is conceptually appealing in managing cardiogenic shock and mechanical complications of myocardial infarction. A common myth is that this method of managing acute cardiological emergencies is to be limited to the realms of this specialist field. However, as medical physicians an appreciation and understanding of this novel therapy is essential not only as a lifesaving measure but also as a bridging therapy to more definitive management in the acute medical setting. IABPC is a safe and under-utilized technique despite featuring in all major international guidelines (ESC and ACC) for the management of cardiogenic shock secondary to acute coronary syndromes. Without awareness of this intervention we may be suboptimally managing patients in the first instance. To improve awareness we examine the evidence supporting the use of the IABPC therapy and the contraindications to their use. Complications and advances in technology are also addressed.     

24h血压监测在48例心肌梗死患者病情评估中的临床研究

[目的]了解24h血压监测在心肌梗死患者病情评估中的临床应用价值。[方法]选择2009年1月～2010年12月某院收住的48例心肌梗死患者。对照分析心肌梗死患者不同时期24h动态血压及不同程度心肌梗死者血压昼夜节律情况。[结果]心肌梗死患者不同时期24h动态血压对照显示,差异性显著。不同程度心肌梗死者血压昼夜节律情况对照显示,血压昼夜节律正常者和减弱者构成比无差异性;消失者构成比差异性显著。[结论]心肌梗死时患者会出现血压昼夜节律减弱或消失,且其减弱或消失的变化与心肌梗死程度有一定的相关性,可利用24h血压监测来辅助诊断心肌梗死情况。     

非典型急性心肌梗死患者的早期诊断及急诊处理

目的探讨对非典型急性心肌梗死患者的早期诊断及急诊处理的临床效果。方法选取2007年8月～2011年6月于某院治疗的非典型AMI患者46例,对患者临床进行回顾性分析。结果 46例患者初诊误诊为急性心功能衰竭1例,心律失常1例,急性胃炎2例,急性肠炎1例,急性胆囊炎2例,休克1例;经治疗,46例患者痊愈出院17例(36.96%),好转出院26例(56.52%),死亡3例(6.52%),临床治疗有效43例(93.48%)。结论及时准确的诊断和急诊处理可以有效实现对梗死部位心肌细胞的再灌注,缩小心肌缺血面积,减少心肌损伤,减少各种并发症的发生和患者死亡率,对非典型AMI患者的临床预后具有重要作用。     

Intramyocardial dissecting haematoma: an unusual form of cardiac rupture

The intramyocardial dissecting haematoma is an unusual rupture of the left ventricular wall, complicating acute myocardial infarction. The mechanism is an hemorrhagic dissection among the spiral myocardial fibres creating a neocavitation limited by the myocardium. It appears in 9% of left ventricular wall ruptures, complicating acute myocardial infarction. Diagnosis is often difficult and in most of the cases it is post-mortem. We present the case report of a 69 year old patient who suffered a posterolateral acute myocardial infarction treated with primary PTCA/Stent plus AAS, clopidogrel, unfractioned heparin bolus and GP IIb- IIIa inhibitors. In the following few hours he suffered this unusual form of cardiac rupture that took him into cardiogenic shock and finally led to his death. The pathophysiology, diagnosis and management of this lethal complication of acute myocardial infarction (90% mortality in the medically treated group) which is only effectively treated by surgery are also reviewed.     

Successful use of levosimendan in a patient with cardiogenic shock complicating acute myocardial infarction

Levosimendan is a new inodilator that improves cardiac contractility by sensitizing troponin C to calcium. This drug has proved to be effective in treating advanced congestive heart failure but has not been evaluated in cardiogenic shock. We present the case of a 54-year-old male patient treated successfully with levosimendan for cardiogenic shock following acute myocardial infarction. Treatment with dobulamine. revascularisation and itra-aortic balloon conterpulsation had first failed to improve his hemodynamic variables. Levosimendan induced a steady decline of increased pulmonary capillary wedge pressure, followed by an increase in cardiac index and mixed venous oxygen saturation. Left ventricular ejection fraction improved from 25% to 47%. Infusion of levosimendan can be used in cardiogenic shock without side effects and to improve hemodynamics and left ventricular function.