主动脉内球囊反搏置入时机对老年急性心肌梗死并心源性休克的疗效观察  

Curative effect of early intra-aortic balloon pump implantation on acute myocardial infarction complicating cardiac shock in elderly patients

作　　者：裘毅钢[1] 李田昌[1] 陈宇[1] 李贤峰[1] 曹毅[1] 田海涛[1] 王兆君[1] 王志国[1] 李东韬[1] 

机构地区：[1]中国人民解放军海军总医院心脏中心,北京100048

出　　处：《中国循证心血管医学杂志》2014年第6期727-729,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的：探讨主动脉内球囊反搏（IABP）置入辅助时机对老年急性心肌梗死合并心源性休克患者临床疗效的影响。方法连续选择自2011年1月-2014年3月心内科收治的116例年龄大于65岁的IABP辅助治疗急性心肌梗死合并心源性休克的患者，按照心源性休克发生至IABP置入的时间，将其分为两组，A组（n=53）为心源性休克至IABP置入时间小于等于3 h，B组（n=63）为大于3 h；观察血运重建、多巴胺使用情况，并记录总IABP辅助时间，30 d内全因死亡、急性呼吸衰竭、急性肾功能衰竭、主要出血事件等临床事件。结果多巴胺使用无统计学差异。平均IABP辅助时间A组低于B组（71.0 hvs.128.5 h，P＜0.01）；A组与B组相比，全因死亡两组间有统计学差异（15.1%vs.31.7%，P＜0.05）；心源性死亡（13.2%vs.25.4%，P=0.10）、急性呼吸衰竭发生率（26.4%vs.34.9%，P=0.32）、急性肾功能衰竭发生率（11.3%vs.20.6%，P=0.18）、主要出血事件（5.7%vs.11.1%，P=0.29）有降低的趋势，但无统计学意义。结论在老年急性心肌梗死合并心源性休克的患者早期应用IABP辅助治疗可能有助于改善30 d内生存率以及减少主要临床事件的发生率。Objective To investigate the curative effect of early intra-aortic balloon pump （IABP） implantation on acute myocardial infarction （AMI） complicating cardiac shock （CS） in elderly patients.Methods The patients （aged over 65,n=116） were chosen from Jan. 2011 to Mar. 2014, and then divided, according to the duration from attack of CS to IABP implantation, into group A （n=53, duration≤3 h） and group B （n=63, duration〉3 h）. The revascularization and dopamine administration were observed, and the total IABP auxiliary time, all-cause mortality within 30 d, acute respiratory failure, acute renal failure and major bleeding events were recorded. Results There was no statistical difference in dopamine administration. The average IABP auxiliary time was shorter in group A than that in group B （71.0 hvs. 128.5 h,P〈0.01）. There was statistical difference in all-cause mortality between 2 groups （15.1%vs. 31.7%,P〈0.05）. The incidence of cardiac death （13.2%vs 25.4%,P=0.10）, acute respiratory failure （26.4%vs. 34.9%,P=0.32）, acute renal failure （11.3%vs 20.6%,P=0.18） and major bleeding events （5.7%vs. 11.1%,P=0.29） showed a decreasing trend but without statistical significance.Conclusion The early IABP implantation maybe improve survival rate within 30 d and reduce the incidence of major clinical events in elderly patients with AMI complicating CS.

关 键 词：主动脉球囊反搏 急性心肌梗死 心源性休克 

分 类 号：R543.1[医药卫生—心血管疾病]