主动脉内球囊反搏在急性心肌梗死并发心源性休克中的应用

目的　评价主动脉内球囊反搏 (IABP)对急性心肌梗死合并心源性休克患者在不同血管再通治疗中的疗效和短期生存的影响。方法　回顾性分析了 10 8例接受IABP治疗的急性心肌梗死合并心源性休克患者 ,分别分析了溶栓治疗组、介入治疗组和冠脉搭桥 (CABG)手术治疗组患者的基本特征和血流动力学情况 ,并比较IABP治疗对住院病死率和 30d病死率的影响。结果　患者的基本特征包括年龄、冠心病的危险因子等在各组间差异无显著性意义 (P >0 0 5 ) ,但手术治疗组的男性患者显著少于其它两组 (P <0 0 5 ) ;IABP治疗前血流动力学状态各组间也无显著性意义 ,住院病死率和 30d病死率手术治疗组均显著低于溶栓组和介入组 ,分别为 18 9%、 6 2 8%和 6 0 7% ,16 2 %、 6 0 5 %和 6 0 7% ,P值均 <0 0 0 1。结论　IABP支持下进行CABG治疗可显著减低心肌梗死合并心源性休克患者的近期死亡率 ,且显著优于溶栓治疗和介入治疗

Evaluation of application of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicated with acute myocardial infarction

Objective To evaluate the therapeutic effect of intra aortic balloon counterpulsation(IABP)on short term survival in patients with acute myocardial infarction complicated with cardiogenic shock treated with different methods of revascularization.Methods 108 patients with cardiogenic shock complicated with acute myocardial infarction and treated with IABP were analysed retrospectively.The patients were divided into thrombolytic group(TT),percutaneous coronary interventional group(PCI),and coronary artery bypass graft(CABG) group.The basic characteristics and hemodynamic parameters of patients in three different groups and the effect of IABP on the short term survival were compared.Results There was no significant difference in basic characteristics among the groups,except that the male female ratio in CABG group was lower than that in other two groups;the hemodynamic parameters were not different among the three groups.However,in hospital mortality and 30 day mortality in CABG group were obviously lower than those in TT and PCI.The mortality of in hospital and 30 day in TT,PCI and CABG were 62 8% and 60 7% vs 18 9%,60 5% and 60 7% vs 16 2%,respectively, P <0 001.Conclusion CABG combined with IABP treatment in patients with cardiogenic shock complicated with acute myocardial infarction can significantly decrease the short term mortality and is much better than the treatment of TT and PCI.. [