危重冠心病围术期主动脉内球囊反博的临床应用分析

目的 回顾性总结危重冠心病围术期应用主动脉内球囊反博（1ABP）的经验,分析IABP置入的时机与临床治疗结果的关系,为提高IABP在危重冠心病患者的临床应用疗效提供依据.方法 1999年7月-2009年7月行冠状动脉搭桥术385例,其中21例病人围术期应用IABP辅助.将21例分为预防性主动置入组（主动组）8例和紧急被动置入组（被动组）13例.观察两组病人IABP使用的临床效果,包括围术期死亡率、IABP置入相关的严重并发症、平均辅助时间、血压改善情况、呼吸机辅助时间、ICU治疗时间等临床指标.结果 本组IABP应用占同期冠心病外科手术病人的5.5%.21例病人中,存活15例,死亡6例,总有效率71%,主动组术后死亡率明显低于被动组（P＜0.01）.两组的血压上升幅度、呼吸机辅助时间和ICU治疗时间差异有显著性（P＜0.05）,但两组的术后并发症发生率、IABP辅助时间差异无显著性（P＞0.05）.结论 对于术前评估为危重冠心病患者,术前预防性主动置入IABP能明显改善心功能,降低术后死亡率,缩短呼吸机辅助时间和ICU治疗时间,充分发挥IABP临床疗效.

Clinical analysis of perioperative application of intra-aortic balloon pump in high-risk coronary artery bypass grafting

Objective To review the perioperative application of intra-aortic balloon pump (IABP) in high-risk coronary artery bypass grafting (CABG), and to analyze the relation between inserting time and clinical outcomes.Methods From July 1999 to July 2009, 385 patients underwent CABG and 21 of them were supported with IABP in our hospital. 21 were divided into two groups : group A (8 cases) supported preoperatively, and group B (13 cases) supported urgently. Postoperative mortality, severe IABP-related complications, supporting time, improvement of blood pressure, ventilation time, and length of ICU stay were compared. Results Of the patients undergoing CABG, IABP was 5.5%. 15 of all the patients survived. The rate of efficacy was 71%. Mortality was lower in group A than in group B (12.5%±2.1% vs. 38.5%±4.3%,P<0.01). There were significant differences between the two groups in improvement of blood pressure (35.4 ± 4.6 in group A vs. 18.2 ± 3.0 in group B, P