主动脉内球囊反搏术在ST段抬高型心肌梗死患者中不同TIMI评分的疗效分析

目的:探讨IABP辅助治疗对不同的TIMI评分的ST段抬高型心肌梗死(STEMI)患者,近期疗效的影响。方法:回顾性分析本院心内科,2005年7月至2013年7月间,未发生机械并发症(室间隔穿孔、严重瓣膜反流及心脏游离缘破裂)并且院内生存24小时以上的急性心肌梗死患者898例的临床资料,其中应用IABP机械辅助的有294例患者。将患者按照针对STEMI的TIMI评分方法分为低危组(0~3分)、中危组(4~7分)、高危组(8~14分)。分析不同危险度患者应用IABP辅助治疗的临床效果。结果:低危组429例患者中,应用IABP的患者数量较少(23例),IABP治疗组与常规治疗组均无院内死亡,未见明显不同;在中危组(293例)中,IABP治疗组(119例)与常规治疗组(174例)相比,院内病死率明显降低(5.0%vs.12.1%,P0.05);高危组(176例)中,应用IABP患者(152例)较常规药物治疗组(24例)院内病死率较低(18.4%vs.29.2%),但无统计学差异(P=0.220)。多变量Logistic回归结果:IABP为具有统计学意义的保护因素(OR=0.109,95%CI:0.025~0.484,P=0.004)。结论:在TIMI评分4-7分(中危组)的患者中,应用IABP可以提高患者在院期间生存率。

The in-hospital outcome of IABP support in STEMI patients according to different TIMI risk scores

Objective：To investigate the in-hospital outcome of patients with STEMI treated with IABP counterpulsation according to different TIMI risk scores. Methods： The clinical data of 898 STEMI patients without Mechanical complications from July 2005 to July 2013 were retrospectively analyzed. All patients survived in the first 24 hours after admission. The evolution of in-hospital outcomes was compared in the 294 patients with IABP vs. those without IABP; Patients fell into three risk stratification according TIMI risk score： low risk group （0 - 3 scores） ; median risk group （4 -7 scores） ; high risk scores （8 - 14 scores）. Results： In the low risk group（ n = 429 ） , there is no difference between those with（ n = 23 ）or without IABP（ n = 406） （no death） ; in the group of median risk（ n = 293 ） , patients with IABP（ n = 119） had a lower mortality rates（ 5.0% vs. 12. 1% ,P 〈0.05 ） ; in the high risk group（ n = 176） , patients with IABP（ n = 152） had a lower mortality rates than those without IABP（24 ） （ 18.4% vs. 29. 2% , P = 0. 563 ） , but is not statistically significant. Binary logistic regression shows that IABP is an independent protective factor （OR = 0. 109,95% CI： O. 025 -0. 484, P = 0. 004）. Conclusion： IABP may reduce mortality among STEMI patients in TIMI score 4-7.