主动脉内球囊反搏术治疗心源性休克

目的 回顾性分析主动脉球囊反搏(intra-aortic balloon counterpulsation,IABP)治疗心源性休克的疗效.方法 IABP治疗心源性休克38例,其中急性心肌梗死34例,病毒性心肌炎4例.利用无创血流动力学监测系统(Bioz.com)连续监测患者IABP术前和术后的血流动力学改变.结果 患者心率、平均动脉压、心输出量、顺应指数、左心室做功指数、胸液量、系统血管阻力等血流动力学指标均得到明显改善(P＜0.05),在急性心肌梗死患者34例中,24例行冠状动脉造影术,15例行球囊扩张术及支架植入术,术后死亡7例.5例行冠状动脉旁路移植术,术后死亡2例;治疗组总病死率为9/20(45%).未治疗组14例,死亡12例(12/14,86%);4例病毒性心肌炎死于心源性休克患者3例.结论 IABP能明显改善心源性休克患者的血流动力学指标,对急性心肌梗死合并心源性休克疗效好.

Application of intra-aortic balloon counterpulsation in patients with cardiogenic shock

Objectives To evaluate the effect of intra-aortic balloon counterpulsation (IABP) on patients with cardiogenic shock. Methods 38 patients were all installed with IABP. adopting noninvasive hemodynamic measure system both determined before and after IABP in patients with cardiogenic shock. Haert rate (HR), cardiac output (CO), accleration index (ACI), thorcic fluid content (TFC), left cardiac work index (LCWI), systemic vascular resistance (SVR) were measured. Results All patients acquired the stable hemodynamics following IABP. The results showed that after IABP, MAP,CO, ACI, LCWI were increased(P<0.05), HR, TFC, SVR were decreased(P<0.01).34 patients with cardiogenic shock complicating AMI,24 patients underwent coronary angiography and 14 patients were treated with PTCA, 3 patients died, 5 patients were treated with CABG, 2 patients died, in treatment groups, the total mortality was 45%(9/20). In contrals groups, the total mortality was 85.7%(12/14).4 patients with viral myocarditis, 3 patients died, the mortality was 75%. Conclusions IABP can improve the hemodynamic stabilization, and is an effective method for cardiogenic shock complicating AMI.