主动脉内球囊反搏在高危冠状动脉旁路移植术患者中的应用  

Application of Intra-aortic Balloon Pump During Coronary Artery Bypass Surgery in High Risk Patients

作　　者：郑慧萍[1] 徐敏[1] 万峰[1] 张喆[1] 冯海波[1] 

机构地区：[1]北京大学第三医院心外科,北京100191

出　　处：《中国微创外科杂志》2015年第10期868-871,875,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的：探讨术前主动置入和术中／术后被动置入主动脉内球囊反搏（intra-aortic balloon pump，IABP）对高危冠状动脉旁路移植术（coronary artery bypass graft，CABG）患者的应用价值。方法回顾性分析2010年3月～2012年12月我院高危 CABG 患者围手术期使用 IABP 90例资料，根据 IABP 置入的时机将患者分为 A、B 两组。A 组31例，术前预防性使用IABP；B 组59例，术中或术后应用 IABP。比较2组围手术期表现及随访期间主要心脑血管事件（major adverse cardiac or cerebrovascular events，MACCE）的差异。结果与 B 组相比，A 组 ICU 停留时间短[（70．2±50．5）h vs．（123．2±95．8） h，t ＝－3．436，P ＝0．010]；术后 IABP 支持时间（入 ICU 到 IABP 撤离）短[（21．8±13．9）h vs．（65．6±25．3）h，t ＝－10．576，P ＝0．000]；术后房颤少[0％（0／31）vs．23．7％（14／59），P ＝0．002]；术后急性肾损伤少[19．4％（6／31）vs．50．8％（30／59），χ2＝8．398，P ＝0．004]。随访（30．0±12．3）月，MACCE 两组比较无显著性差异。结论术前合理使用IABP，使 CABG 高危风险患者有良好的近期效果。Objective To investigate the effects of intra-or post-operative preventative intra-aortic balloon pump （IABP） insertion in high risk coronary artery bypass patients. Methods From March 2010 to December 2012,90 consecutive patients undergoing coronary artery bypass graft （CABG）with IABP support were observed.The group A included 31 patients with preoperative IABP insertion,and the group B included 59 intra-or post-operative IABP insertion.Peri-operative clinical data and major adverse cardiac or cerebrovascular events（MACCE）during follow-ups were compared between the two groups. Results The ICU stay time was shorter significantly in the group A than in the group B [（70.2 ±50.5）h vs.（123.2 ±95.8）h,t =-3.436,P =0.010].The postoperative IABP support time in the group A was shorter than that in the group B [（21 .8 ±13.9 ）h vs.（65.6 ±25.3 ）h,t =-10.576,P =0.000].The postoperative atrial fibrillation rate was lower in the group A than in the group B [0% （0 /31 ）vs. 23.7% （14 /59）,P =0.002].The postoperative acute kidney injury （AKI）rate was significant lower in the group A than in the group B [19.4% （6 /31 ）vs.50.8% （30 /59）,χ2 =8.398,P =0.004].During follow-ups for （30.0 ±12.3）months,there were no differences in MACCE rate between the two groups. Conclusion Preventive preoperative use of IABP may help improve early outcomes in high risk CABG patients.

关 键 词：主动脉内球囊反搏 冠状动脉旁路移植术 高危患者 

分 类 号：R654.2[医药卫生—外科学]