主动脉内球囊反搏在高危急性冠脉综合征中的应用  

Application of intra -aortic balloon counterpulsation in high -risk acute coronary syndrom

作　　者：张鹏飞[1] 钟志雄[1] 李斌[1] 

机构地区：[1]广东省梅州市人民医院心血管内科,广东梅州514031

出　　处：《中国医药导报》2013年第19期57-59,共3页China Medical Herald

基　　金：广东省梅州市科技计划项目(编号2010B49)

摘　　要：目的评价主动脉内球囊反搏（IABP）在高危急性冠状动脉综合征（ACS）患者辅助治疗中的作用。方法回顾性分析2009年8月~2011年8月68例经皮冠脉介入治疗术的ACS患者应用IABP临床资料,根据IABP置入方法不同分为两组,预防性置入组和被动紧急置入组,每组各34例。分析两组术后临床效果,比较两组术后死亡率、并发症发生率、术后心血管活性药物应用、IABP使用时间、术后机械通气时间、住ICU时间。结果血流动力学不稳定患者接受IABP治疗后,血流动力学稳定,有接受血运重建治疗的患者辅以IABP,没有发生血管再闭塞事件。两组患者中30 d内死亡19例,其中预防性置入组3例（8.82%）,被动紧急置入组16例（47.06%）,两组比较差异有统计学意义（P〈0.05）;预防性置入组明显出血2.94%（1/34）、血肿2.94%（1/34）;被动组明显出血8.82%（3/34）、肢体血运障碍5.88%（2/34）、相关发热2.94%（1/34）,预防性置入组并发症发生率明显低于被动组（P〈0.05）;预防性置入组术后平均正性肌力药物辅助时间、IABP使用时间、术后机械通气时间、住ICU时间分别为（57.63±13.66）、（54.75±17.68）、（31.83±14.71）、（76.35±27.27）h;被动组分别为（94.63±22.72）、（93.12±32.21）、（89.34±35.17）、（102.41±34.12）h,两组比较差异均有统计学意义（均P〈0.05）。结论对于高危ACS合并血流动力学不稳定或心源性休克的患者的LABP可以完全地作用并有效地稳定血流动力学状态,对经最大耐受量内科药物治疗后难治性不稳定心绞痛患者,辅以IABP预防性治疗,有一定的缓解及改善作用。Objective To evaluate the application of intraaortic balloon counterpulsation （IABP） in high-risk patients with acute coronary syndrome （ACS） the role of adjuvant therapy. Methods A retrospective analysis was carried out in August 2009 to August 2011, 68 cases of percutaneous coronary intervention treatment of ACS application of IABP in patients with clinical data were selected and divided into IABP placement methods preventive placement group and passive emergency group, each group （n = 34）. Postoperative clinical effect, compared two groups of postoperative mortality, complications, postoperative cardiovascular active pharmaceutical application, IABP living time, postoperative mechanical ventilation time and ICU were analyzed. Results Hemodynamic instability patients after IABP therapy, hemodynamic stability, have received revascularization in the treatment of patients with IABP, no vascular occlusion events. Two groups of patients in 30 d and 19 cases died, the prophylactic implantation group 3 cases （8.82%）, passive emergency in the group of 16 cases （47.06%）, there was significant difference between two groups （P 〈 0.05）; prevention group in the group were 2.94% （1/34） bleeding, hematoma in 2.94% （1/34）; passive group significant bleeding 8.82% （3/34） of limb blood circulation disorder 5.88%（2/34）, fever in 2.94% （1/34）, prevention of complications of implantation group was significantly lower than the passive group （P 〈 0.05）; prophylactic implantation group average postoperative inotropic drug auxiliary time, IABP time, postoperative mechanical ventilation time, length of stay in ICU respectively. （57.63±13.66）, （54.75±17.68）, （31.83-＋14.71）, （76.35±27.27） h; passive group were （94.63±22.72）, （93.12 ＋32.21）, （89.34±35.17）, （102.41 ±34.12） h, the difference between the two groups there was statistically significant （P〈 0.05）. Conclusion For high-risk ACS combined hemodynamic instability or cardiac shock in pa

关 键 词：急性冠脉综合征 主动脉内球囊反搏 血流动力学 血运重建治疗 心源性休克 

分 类 号：R541.4[医药卫生—心血管疾病]