在高危急性心肌梗死患者急诊治疗中的应用  

Application of intra-aortic balloon pump and acute percutaneous coronary intervention in acute myocardial infarction patients

作　　者：杨向阳[1] 阮云军[1] 何建新[1] 

机构地区：[1]广州军区广州总医院心血管内科,广东广州510010

出　　处：《中国热带医学》2014年第3期341-344,共4页China Tropical Medicine

摘　　要：目的探讨对高危急性心肌梗死患者早期在主动脉球囊反搏术(Intra-aortic balloon pump,IABP)支持下急诊经皮冠状动脉介入治疗(Percutaneous coronang intervention,PCI)的有效性、安全性和对近期预后的影响。方法对122例高危急性心肌梗死患者,床旁预先植入IABP,早期在IABP支持下2h内行急诊PCI手术,分析转规与安全性。结果 122例置入IABP的术后患者SBP、DBP、MAP、SaO2、HR、PCWP、LVEF、CI较术前明显改善,均成功实施急诊PCI术。IABP平均使用时间(48±16)h,10例患者发生了与IABP相关并发症,但无1例严重并发症。穿刺部位小血肿4例,占3.28%;穿刺部位渗血3例,占2.46%;出现术侧患肢远端缺血2例,占1.64%,经回撤IABP鞘管后症状消失;反搏不良1例,占0.82%。置入IABP患者平均住院时间为(7.5±4.9)天,死亡8例,病死率6.56%,住院存活率为93.40%(114)。结论及早对高危急性心肌梗死患者行IABP支持下PCI,有利于改善患者的心功能,降低病死率。Objective To assess the effectiveness and safety of early implantation of intra-aortic balloon pump （IABP） and acute percutaneous coronary intervention（PCI） in treatment of high risk patients with acute myocardial infarction（AMI） . Methods The 122 high risk AMI patients were inserted with IABP and then given acute PCI in 2 hours, and the application time, rules and safety of IABP were analyzed. Result The 122 patients were all inserted with IABP successfully. The index of systolic blood pressure（SBP）,diastolic blood pressure （DBP）, mean arterial pressure （MAP）,oxygen asturation （SaO2）, heart rate （HR）, pulmonary capillary wedge pressure （PCWP）, left ventricular ejection infarction （LVEF）and cardiac index （CI）were improved after implantation of IABP combined with successful PCI. The average time in use of IABP was （48 ±16） hours, and complications of IABP occurred to 10 patients （8.20%）including 4 cases with small hematoma due to puncture （3.28%）, 3 cases with bleeding wound also due to puncture （2.46%）2 cases with lateral distal limb ischemia （1.64%） and inadequate counterpulsation in 1 case（0.82%）. Average hospitalization time of patients inserted with IABP was（ 7.5±4.9 ）days, there were 8 death cases （6.56%） included 7 cases. The survival rate of hospitalized cases was 93.40% （114/122） with the fatality of 6.56%. Conclusion Early implantation of IABP combined with acute PCI can improve cardiac function ~ decrease in-hospital death risk and improve procedural safety in high risk patients with AMI.

关 键 词：高危急性心肌梗死 主动脉内球囊反搏术 急诊经皮冠状动脉成形术 

分 类 号：R542.22[医药卫生—心血管疾病]