主动脉球囊反搏术及多巴胺对急性心肌梗死合并泵功能衰竭行介入治疗的辅助疗效

目的前瞻性对比研究主动脉球囊反搏(IABP)和多巴胺在急性心肌梗死(AMI)合并泵功能衰竭行经皮冠状动脉介入治疗(PCI)的辅助疗效。方法收集AMI合并泵功能衰竭患者57例,按先后顺序分成IABP组(26例)和多巴胺组(31例)。采用Swan-Ganz漂浮导管测定血流动力学参数,常规行(PCI),超声观察3月后左心室射血分数(LVEF)。结果IABP和多巴胺两组治疗后平均肺动脉压(MPAP)、肺毛细血管嵌压(PCWP)较治疗前明显下降,动脉收缩压(SBP)、心脏指数(CI)较治疗前明显上升,有显著性差异,同时,治疗后在MPAP和PCWP下降幅度和SBP及CI上升幅度方面,IABP优于多巴胺,也有差异显著性;比较治疗后即刻成功率及3个月后LVEF,IABP明显高于多巴胺(分别为85%∶71%和55%±14%∶42%±18%,P<0.05),死亡率、住院时间和稳定血流动力学所需要时间IABP明显低于多巴胺分别为15%∶19%和(17±6.2)d:(23±8.9)d和(4.5±3.2)d:(6.5±3.8)d,所有P<0.05。两组共有10例死于泵衰竭、上消化道出血、多脏器功能衰竭。结论IABP和多巴胺皆可作为AMI合并泵功能衰竭行PCI术围手术期的一种辅助治疗手段,IABP较多巴胺疗效更优越。

Additional efficacy of IABP and dopamine in the treatment of acute myocardial infarction complicated with pump failure during PCI

Objective To evaluate the additional efficacy of intraaortic balloon pump(IABP) and dopamine in the treatment of acute myocardial infarction(AMI) complicated with pump failure before and after percutanous coronary intervention(PCI). Methods 57patients with AMI and pump failure were divided into IABP(26 cases) and dopamine group(31cases) respectively. Hemodynamic indexes were measured by Swan-Ganz Guiland morntoring, PCI were performed until patients conditions improved, left ventricular ejection fraction(LVEF) were mearsured by echocardiography after 3 months from PCI. Results mean pulmonary atery pressure(MPAP)and pulmonary capillary wedged pressure (PCWP) were dropped, systolic blood pressure(SBP) and cardial index(CI) were highed significantly than before treatment in two groups. IABP was prevailing over dopamine in the degress of dropping MPAP and PCWP and in the degress of highing SBP and CI, there was significantly statistical difference in two groups; Otherwise, IABP was higher than dopamine in successful rate and LVEF (85%∶71% and 55±14%∶42±18% ,respectively.P≤0.05) and lowwer than dopamine in death rate, in hospital timing and timing for stable the hemodyname (15%∶19%,17±6.2d:23±8.9d and 4.5±3.2d:6.5±3.8d, respectively. all P≤0.05 ). Ten patients died of pump failure, upper gastrointestinal haemorrhage, multiple organ dysfunction. Conclusion As a kind of additional treatment of AMI with pump failure during PCI, IABP is more effective than dopamine.