主动脉球囊反搏联合参附注射液对急性心肌梗死合并泵衰竭行PCI治疗患者的疗效观察

目的分析主动脉球囊反搏联合参附注射液对急性心肌梗死合并泵衰竭行冠状动脉介入治疗的临床疗效。方法选择2013年1月~2015年12月在咸阳市中心医院心血管内科诊治的急性心肌梗死合并泵衰竭患者90例,将其随机分为主动脉球囊反搏术组(41例)和多巴胺组(49例),主动脉球囊反搏术组给予主动脉球囊反搏术联合参附注射液治疗,多巴胺组给予多巴胺治疗。观察并记录两组患者的住院时间、维持血流动力学稳定所需时间和围手术期并发症的发生情况;检测收缩压(SBP)、肺毛细血管嵌压(PCWP)、平均肺动脉压(MPAP)和心脏排血指数(CI)。结果与多巴胺组相比,主动脉球囊反搏术组的纠正心力衰竭成功率明显升高(P0.05),而住院时间、维持血流动力学稳定所需时间和死亡率均明显降低(P0.05);治疗后两组MPAP和PCWP均明显降低(P0.05),SBP和CI均明显升高(P0.05),而主动脉球囊反搏术组MPAP、PCWP、SBP和CI的改善程度明显优于对照组(P0.05)。结论主动脉内球囊反搏术联合参附注射液能明显改善急性心肌梗死合并泵衰竭患者的血流动力学,较多巴胺疗效优越。     

主动脉内球囊反搏应用时机的选择与疗效分析

目的探讨主动脉内球囊反搏术临床应用时机的选择与治疗的疗效。方法选取我院2009年6月~2013年6月收治的重症心脏病患者48例作为研究对象,分析应用主动脉内球囊反搏辅助治疗的疗效以及影响预后的因素。结果主动脉内球囊反搏术治疗时间42~160 h,平均时间(92±16)h,死亡10例,病死率为21%,发生并发症9例,其中严重肢体缺血1例,栓塞5例,大出血1例,内球囊破裂2例,并发症发生率为19%。结论主动脉内球囊反搏术在危重心脏病并发心源性休克的治疗中具有明显的疗效,为了保证主动脉内球囊反搏术治疗的疗效,选择适当的应用时机,有着极为关键的意义。     

主动脉球囊反搏支持下高危患者急性心肌梗死介入治疗的疗效观察

目的评价高危急性心肌梗死患者行急诊介入治疗术时常规主动脉内球囊反搏术（IABP）的可行性及其疗效。方法选择20例行介入治疗的高危急性心肌梗死（AMI）患者,应用主动脉内球囊反搏术（IABP）辅助治疗。结果本组20例患者应用IABP治疗时间1～7d,平均（2.25±1.40）d。应用IABP治疗后血压均明显增高（P〈0.05）,心率明显减慢（P〈0.05）。结论高危急性心肌梗死患者在主动脉内球囊反搏支持下行急诊冠脉介入治疗可增加治疗的安全性、降低病死率、减少血管再闭塞率、提高手术成功率。     

心肌梗死后室间隔穿孔的早期诊断和治疗

本文报告１７例心肌梗死后室间隔破裂，其中９例死亡。７例手术患者中，除１例手术死亡外，６例手术治行效果满意。文中对其常见临床诊断特点进行了分析讨论，并阐述了行之有效的诊断方法。同时认为内科药物治疗及主动脉内球囊反搏术辅助只能在一定程度上缓解衰竭的心脏，外科手术修补室间隔破裂口是唯一的最佳治疗方法。     

主动脉内球囊反搏急性心肌梗死介入术后心功能低下的疗效观察

目的观察主动脉内球囊反搏术（IABP）应用于急性心肌梗死冠状动脉介入治疗术后心功能衰竭的疗效。方法 28例急性心肌梗死行急诊经皮冠状动脉介入术（PCI）后合并急性左心力衰竭患者,静脉使用血管活性药物仍不能维持有效血液循环,经股动脉置入主动脉内球囊反搏导管,行IABP。观察尿量、心率、意识改变、有创动脉收缩压（SABP）和平均动脉压（MABP）。结果 IABP后,患者SABP、MABP明显高于术前（P〈0.01）。23例患者心功能均有不同程度改善,心率减慢,尿量增多,心功能改善不明显3例,死亡2例。结论主动脉内球囊反搏术能有效改善PCI术后低心排血量病人的心功能。     

主动脉内球囊反搏术在急性冠状动脉综合征治疗中的作用

目的评价主动脉内球囊反搏(IABP)在急性冠状动脉综合征治疗中的作用. 方法2001年3月～2003年9月间应用主动脉内球囊反搏术治疗41例急性冠状动脉综合征患者,评价临床疗效.其中男性30例,女性11例;年龄42～87(63.5)岁.     

主动脉球囊反搏术治疗急性心肌梗死伴发心源性休克的护理体会

目的探索应用主动脉球囊反搏术治疗急性心肌梗死伴发心源性休克的治疗效果及护理方法。方法对我院9例急性心肌梗死伴发心源性休克患者应用主动脉球囊反搏术治疗并精心护理。结果本组患者再治疗后收缩压、舒张压、血氧饱和度明显提高、心功能明显改善,心率下降、尿量增加。结论对急性心肌梗死伴发心源性休克患者应用主动脉球囊反搏治疗,具有良好的近期疗效,并发症少,积极的预防治疗护理措施则能减少并发症,降低死亡率,促进患者康复。     

经主动脉球囊反搏术辅助治疗急性心肌梗死并泵衰竭55例护理体会

2006年9月-2009年10月，我们应用主动脉球囊反搏术（IABP）辅助治疗急性心肌梗死并泵衰竭55例，取得满意疗效。现报告护理体会。     

主动脉球囊反搏术治疗心血管重症的疗效分析

目的:探讨主动脉球囊反搏术治疗心血管重症的临床疗效。方法:选取心血管内科重症病房患者60例,按随机数字表法分为实验组和对照组。实验组应用主动脉球囊反搏术,对照组应用常规药物,观察2组患者的心率、血压、尿量、多巴胺用量、心功能分级及病死率。结果:治疗7 d后实验组好转和稳定病例数明显高于对照组(76.7%vs 50%,P0.05)。治疗后2组患者心率降低,收缩压和舒张压升高,尿量增加,多巴胺用量、脑钠肽和心功能评分均降低,与治疗前比较差异有统计学意义(P0.05)。结论:主动脉球囊反搏术可有效治疗急性重症心力衰竭和心肌梗死,降低病死率。     

预见性护理对主动脉内球囊反搏术后患者预防下肢深静脉血栓形成的效果观察

目的观察预见性护理对主动脉内球囊反搏术后患者预防下肢深静脉血栓形成的效果观察。方法选取2018年2月至2019年2月在我院收治的32例主动脉内球囊反搏术后患者为观察组,采用回顾性研究选取2017年1月至2018年1月在我院收治的31例主动脉内球囊反搏术后患者作为对照组。对照组采取一般常规指导,观察组采取预见性护理干预,对两组下肢深静脉血栓发生率和护理满意度进行了统计学分析。结果观察组护理效果明显,下肢深静脉血栓发生率降低且护理满意度高,两组数据比较差异有统计学意义(P0.05)。结论通过对主动脉内球囊反搏术后患者行预见性护理干预,可有效降低患者下肢深静脉血栓的发生率,并对其预防具有积极意义,并且提高了患者对护理效果的满意度。     

Perforation of the descending aorta by the tip of an intra-aortic balloon pump catheter.

Perforation of the proximal descending aorta occurred in a patient on intra-aortic balloon pump (IABP) support after emergency coronary intervention for acute myocardial infarction. The IABP catheter was inserted under fluoroscopic guidance into the right femoral artery without difficulty, but after 8 h on IABP support the patient went into shock with a left hemothorax. Emergency surgery was performed with cardiopulmonary bypass and a perforation of the proximal descending aorta with active bleeding was found and successfully repaired. A distorted descending aorta in which the IABP catheter was kinked, as in the aortic arch, was discovered during surgery and confirmed postoperatively with 3-dimensional computed tomography scans, particularly in the lateral view. Not only the antero-posterior but also the lateral fluoroscopic view is recommended to prevent aortic perforation by a kinked IABP catheter.     

新型国产隔膜气动左心辅助泵(罗叶泵)的临床试用

目的 总结新型国产隔膜气动左心辅助泵（罗叶泵）临床试用4例病人的经验。临床资料及结果 本组4例病人均为心脏手术后严重低心排出量综合征病人，其中1例合并围术期急性心肌梗死。3例应用主动脉内球囊反博（IABP）效果不满意再行左心辅助，1例直接行左心辅助。左心辅助时间30.3-116h，平均78.1h。本组死亡3例，1例死于肾功能衰竭，1例死于多脏器官功能衰竭，1例死于脑出血。本组存活1例，左心辅助期间出现左颞叶和顶叶脑梗死，右侧肢体偏瘫，经治疗后好转出院，随访6个月，右侧肢体活动明显改善，一般情况尚好。结论 新型国产隔膜气动左心辅助泵（罗叶泵）在抢救心脏手术后严重低心排出量综合征中显示能效满意地维持血流动力学的稳定，有较IABP更显的效果。在应用时要把握时机，尽早应用。然后，左心辅助的应用仍存在安置较为复杂，易渗血等不足之处，有待今后进一步总结经验，加以改进，使国产辅助装置在我国得以更广泛地应用。     

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。     

主动脉内球囊反搏术在急性心肌梗死相关动脉近端病变患者中的应用效果

目的评价主动脉内球囊反搏术在急性心肌梗死相关动脉近端病变患者中的应用效果。方法根据急诊介入治疗后是否应用主动脉内球囊反搏术（IABP）将199例急性心肌梗死相关血管为近端病变患者分为两组,即IABP组（79例）和无IABP组（120例）,比较两组术后2周心肌梗死范围和血脑钠尿肽的变化、两组左室射血分数和左室舒张末期内径及两组术后30d内心脏事件的发生率。结果术后2周和无IABP组比较,IABP组患者梗死范围明显缩小[（30.256±4.223）%vs.（35.343±5.235）%,P〈0.01],血脑钠尿肽浓度降低[（89.7±33.5）ng/Lvs.（128.7±44.1）ng/L,P〈0.01],左室左室射血分数增高[（52.6±5.2）%vs.（47.5±7.3）%,P〈0.01],左室舒张末期内径减小[（47.5±4.6）mmvs.（50.3±5.7）mm,P〈0.01]。术后30d内心脏事件发生率IABP组明显低于无IABP组（P〈0.05）。结论对急性心肌梗死相关动脉近端病变患者急诊介入治疗后行IABP治疗可使心肌梗死范围缩小,改善患者心功能,降低心脏事件的发生率。     

Intra-aortic balloon pumping in infants and children

From November 1981 to November 1982, intra-aortic balloon pumping (IABP) was used after surgery in eight patients who were from 6 weeks to 6 years old and who weighed from 4.2 to 16.2 kg. In seven patients, specially constructed intra-aortic balloons with 2.5 and 5.0 ml volumes mounted on No. 5F catheters were used. In the largest and oldest patient, a two-chamber 10 ml balloon was used. The pumping module used was the Datascope System 82. Effective diastolic augmentation of arterial pressure was accomplished in seven of the eight patients and suprasystolic diastolic augmentation was accomplished in four. The two youngest and smallest patients are the only long-term survivors. There were two short-term survivors who died 5 and 10 days after successful IABP. In only one patient was there no appreciable effect of IABP. Miniaturization of the equipment has permitted IABP to be used effectively in pediatric patients.     

心功能减退患者的非体外循环冠状动脉旁路移植术82例临床分析

目的:总结分析82例射血分数<40%的冠心病患者进行的非体外循环冠状动脉旁路移植术。方法:2002年7月至2012年1月进行的选择性OPCAB手术82例,全部经左心室造影测定射血分数在25%～40%之间,平均(35.2±4.8)%。合并心肌梗死史52例,急性心肌梗死后1个月内6例,不稳定心绞痛24例。心功能Ⅱ级18例,Ⅲ级56例,Ⅳ级8例。冠状动脉造影提示2支病变11例,3支病变53例,左主干18例。结果:全部病例均完成OPCAB手术,平均远端吻合口数目为(2.9±0.8)个,使用主动脉内球囊反搏14例,其中7例在手术中安放。死亡3例,均为术后围术期心肌梗死死亡。有6例术后出现急性左心衰,安放主动脉内球囊反搏后保守治疗好转。其中3例心室颤动,均复苏成功。18例行围术期CCO(持续心排血量)监测,术前CO指数在1.8～3.8之间,平均2.4±0.46,术后第1天CO指数在3.6～7.2之间,平均4.8±1.26。结论:严重心功能减退患者实施OPCAB手术有良好的可行性和近期效果,而长期结果仍有待进一步观察。     

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.     

主动脉内球囊反搏术在冠状动脉搭桥术后心脏泵衰竭中的应用体会

目的总结主动脉内球囊反搏（IABP）在冠状动脉搭桥术（CABG）后心脏泵衰竭应用的临床经验,探讨此类手术应用IABP的时机选择和适应证。方法总结2007年6月至2012年6月,5例因冠心病行CABG后患者出现心脏泵衰竭,在IABP支持下,术后心功能及血液动力学恢复稳定的情况。结果5例患者均在术后3-7d撤除IABP,恢复良好,痊愈出院。结论冠脉病变严重（多支病变、左主干病变）及急性心肌梗死患者,行冠状动脉搭桥术风险较大,特别是术后出现严重的低心排使手术效果更加不确定。术后应用IABP可以有效地改善心功能,提高手术成功率。     

Intraaortic balloon pump insertion through the subclavian artery. Subclavian artery insertion of IABP

The intraaortic balloon pump (IABP) is frequently used in the management of cardiac failure in the setting of myocardial infarction or as a bridge for coronary revascularisation surgery. The IABP is usually inserted through the femoral artery. Occasionally severe aorto-iliac occlusive disease prevents the retrograde passage of the balloon, in which case an anterograde route, usually through the ascending aorta is used. We describe four patients in whom an IABP was placed through the subclavian artery by the joint efforts of cardiologists and vascular surgeons.     

Utilization of low-profile intra-aortic balloon catheters inserted by the sheathless technique in acute cardiac patients: clinical efficacy with a very low complication rate

Initial intra-aortic balloon pump (IABP) catheters were of large caliber and their utilization resulted in a high incidence of complications, including limb ischemia, bleeding and thrombosis, peripheral neurologic sequelae, and infection. Despite eventual decrease in the size of IABP catheters, the complication rate has remained high. Hypothesis: The study was undertaken to determine whether use of recently available low-profile IABP catheters would result in a lower incidence of vascular and bleeding complications. Methods: We prospectively evaluated the incidence of complications when consecutively using the low-profile (8F) IABP catheter inserted mostly sheathlessly in 161 acute cardiac patients between January 1, 2000 and April, 2003. Results: Complications encountered included mild transient limb ischemia in two patients (1.2%), minor bleeding episodes in four patients (2.4%), one major puncture site bleeding (0.6%), and a pseudoaneurysm treated percutaneously in two patients (1.2%). Two patients (1.2%) suffered limb ischemia due to embolization or local thrombosis requiring vascular intervention. These complications were milder and their incidence remarkably lower than those reported previously when IABP catheters larger than 8F were used. Conclusion: Utilization of low-profile IABP 8F catheters in a sheathless technique entails an exceedingly low complication rate despite an acute presentation, intense anticoagulant and antiaggregant therapy, frequent comorbidity, advanced age, severe coronary disease, and reduced cardiac function in a large proportion of treated patients.