急性心肌梗死并休克不同时机应用主动脉内球囊反搏的疗效观察  

Intra-aortic balloon counterpulsation for patients with acute myocardial infarction complicated by shock

作　　者：潘宏伟[1] 郭莹[1] 郑昭芬[1] 何晋[1] 张宇[1] 刘征宇[1] 胡勇军[1] 彭建强[1] 

机构地区：[1]湖南省人民医院心内科,长沙410005

出　　处：《临床心血管病杂志》2014年第5期393-396,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨急性心肌梗死(AMI)后休克患者主动脉内球囊反搏(IABP)辅助治疗时机的选择对治疗效果的影响。方法:AMI并休克患者85例,按IABP应用的时机不同随机分为两组:即刻IABP组(43例)为入院时确诊后立即行IABP术,必要IABP组(42例)为经过积极药物治疗后,收缩压仍然<90mmHg(1mmHg=0.133kPa),再行IABP术。比较两组术后1周以及3个月的生存率,测量两组术后1d、3个月的左室射血分数(LVEF),比较两组术前及术后1周的NT-proBNP。结果:必要IABP组术后3个月生存率明显低于术后1周(57.1%∶69.0%),并低于即刻IABP组(67.4%),均具有显著差异(P<0.05)。术后3个月两组的LVEF值均进行性降低,必要IABP组下降幅度大于即刻IABP组[(7.6±3.5)%∶(4.2±3.1)%,P<0.05]。术后1周两组NTproBNP均明显降低,即刻IABP组下降幅度大于必要IABP组[(7 991±3 375)pg/ml∶(5 089±3 120)pg/ml,P<0.05]。结论:AMI并休克患者尽早使用IABP,能降低全因死亡率,保护左室收缩功能。Objective：To investigate the application opportunity of intra-aortic balloon pump（IABP）for patients with acute myocardial infarction（AMI）complicated by shock.Method：The 85patients with AMI complicated by shock were randomly divided into two groups according to application opportunity of IABP.Immediate IABP group（43cases）underwent the IABP surgery immediately after diagnosis.Necessary IABP group（42 cases）were treated by positive drugs therapy and systolic blood pressure remained90mmHg,then underwent IABP surgery.Left ventricular ejection fraction（EF）of 1day and 3month were measured.The difference of NTproBNP of preoperative and 1week postoperative in two groups were compared.Result：The survival rate of necessary IABP group after 3months was significantly lower than a week postoperative（57.1%vs 69.0%）,and lower than immediate IABP group（67.4%）,there were significant differences（P〈0.05）.LVEF values of two groups after three months were continuously decreased,the necessary IABP group declined more than the immediate IABP group[（7.6±3.5）% vs（4.2±3.1）%,P〈0.05].NT-proBNP of two groups after 1weeks were significantly decreased,immadiate IABP group declined more than necessary IABP group [（7 991±3 375）pg/ml vs（5 089±3 120）pg/ml,P〈0.05].Conclusion：Early use of IABP for patients with AMI complicated by shock,can reduce all-cause mortality,and protect left ventricular systolic function.

关 键 词：急性心肌梗死 休克 主动脉内球囊反搏 经皮冠脉介入治疗 N末端前体脑利钠肽 

分 类 号：R542.2[医药卫生—心血管疾病]