应用主动脉内球囊反搏结合血管重建术治疗急性心肌梗死并发泵衰竭患者的效果

目的:观察应用主动脉内球囊反搏（IABP）结合血管重建术治疗急性心肌梗死并发泵衰竭患者的效果。方法: 2004年12月~2010年12月我院确诊急性心肌梗死并发泵衰竭并应用IABP的住院患者75（男54，女21）例。按是否做血管重建术分为两组:血管重建组和非血管重建组。所有患者均在药物治疗的基础上行IABP，所用反搏仪为AUTO CAT2或Datascope 98 system，血管重建组并行冠状动脉造影及经皮冠状动脉介入术(PCI)或冠脉旁路移植术（CABG）。结果: 全部75例患者中，IABP反搏时间2～336（90±75） h；死亡22例，病死率29%；血管重建组中63例行PCI术，1例行择期CABG,术后死亡14例，病死率22%；非血管重建组中死亡8例，病死率73%。血管重建组的病死率显著低于非血管重建组（P<0.01）,并发症共5例，发生率7%。结论: 在IABP的支持下，积极进行血管重建治疗可以降低急性心肌梗死并发泵衰竭患者的住院期间病死率。

Effect of intra-aortic balloon counterpulsation in patients with acute myocardial infarction and cardiogenic shock

AIM:To investigate the value of intra-aortic balloon counterpulsation (IABP) support therapy for patients suffering from acute myocardial infarction (AMI) complicated with cardiogenic shock. METHODS: Enrolled in the study were 75 consecutive patients ［mean age (69.7±10.2) years, 54 males］ diagnosed from December 2004 to December 2010 with AMI complicated with cardiogenic shock. All patients were treated with IABP, including PCI in 63 cases and CABG in one case. RESULTS: IABP time in the 75 cases was 2-336 h ［mean: (90.1±75.2) h］ and the overall in-hospital mortality was 29.3% (n=22): IABP with and without revascularization, respectively, 21.9% and 72.7%. Incidence of complications was 6.7% including puncture site bleeding in one patient, severe thrombocytopenia in one patient, a large area of cerebral infarction in one patient, and acute pancreatitis in two patients. CONCLUSION: IABP support with revascularization is an effective modality for AMI patients complicated with cardiogenic shock, which significantly lowers hospital mortality. However, the mortality rate remains high without revascularization.