主动脉球囊反搏及联合机械通气治疗心源性休克的比较  

Effect of intra-aortic balloon pump and intra-aortic balloon pump combined with mechanical ventilation in treating cardiogenic shock

作　　者：刘宏伟[1] 吴雪萍[1] 赵晓宁[1] 朱平[1] 韩丽娜[1] 杨庭树[1] 

机构地区：[1]解放军总医院南楼心内科,北京100853

出　　处：《中华保健医学杂志》2016年第3期196-199,共4页Chinese Journal of Health Care and Medicine

基　　金：军队临床高新技术重大项目(2010gxjs093)

摘　　要：目的比较主动脉球囊反搏（IABP）与IABP联合机械通气治疗急性心肌梗死合并心源性休克的临床疗效,探讨更有效的治疗方法。方法回顾性分析2005年1月~2013年12月共71例心肌梗死合并心源性休克患者,药物治疗效果不佳,38例应用IABP（IABP组）,33例应用IABP联合机械通气（IABP＋MV组）,比较两组间基线资料、临床指标、并发症等的差异,并分析影响院内死亡的因素。结果 IABP＋MV组左心室射血分数（LVEF）由治疗前的（36.4±5.2）%增加至治疗后的（43.8±5.3）%（t=5.761,P=0.000）,IABP组由治疗前的（41.7±4.5）%增加至治疗后的（44.0±4.9）%（t=2.103,P=0.039）,可见IABP＋MV组比IABP组增加更显著（t=3.806,P=0.000）。IABP＋MV组肺部感染（χ2=4.283,P=0.038）及肾功能不全（χ2=3.997,P=0.046）发生率明显高于IABP组,肺部感染、肾功能不全与院内死亡的危险性呈正相关,为阳性预测因子;成功血运重建与院内死亡危险呈负相关,为阴性预测因子。结论 IABP联合机械通气,有益于心源性休克患者心功能改善,但并不能降低院内死亡率,降低院内死亡率主要依赖于成功血运重建。IABP联合机械通气可能会增加肺部感染和肾功能不全的发生率,二者也是影响心源性休克患者院内死亡的主要危险因素。Objective To compare the clinical outcomes of intra-aortic balloon pump（IABP）and IABP combined with mechanical ventilation（MV） in treating cardiogenic shock（CS） after acute myocardial infarction（AMI）. Methods From January,2005 to December,2013,71 CS patients who received IABP（IABP group,n = 38） or IABP ＋ MV（IABP ＋ MV group,n = 33） in General Hospital of Chinese People＇s Liberation Army were retrospectively analyzed. More specifically,baseline characteristics,clinical outcomes,mortality,and complications were compared between the IABP group and IABP ＋ MV group. Results IABP ＋ MV group showed more severe disease condition. The left ventricular ejection fraction（LVEF） significantly increased from 36.4 ± 5.2% to43.8 ± 5.4%（t = 5.761,P = 0.000） after treatment in the IABP＋MV group,and from 41.7 ± 4.5% before treatment to 44.0 ± 4.9%（t = 2.103,P = 0.039）after treatment in the IABP group. A more significant improvement of the left ventricular function was observed in IABP ＋ MV group（t = 3.806,P = 0.000）.The incidence of pulmonary infection（χ2= 4.283,P = 0.038） and renal insufficiency（χ2= 3.997,P = 0.046） were higher in the IABP ＋ MV group. Pulmonary infection（P = 0.021） and renal insufficiency（P = 0.018）were risk factors for in-hospital mortality,whereas successful revascularization（P = 0.001） was a negative risk factor. Conclusion IABP ＋ MV seems to provide more beneficial effects on left ventricular function in CS patients. But this does not result in a decrease of in-hospital mortality; without successful revascularization, IABP ＋ MV is unlikely to deliver substantial benefits in terms of survival. IABP ＋ MV may increase the incidence of pulmonary infection and renal insufficiency in CS patients.

关 键 词：主动脉球囊反搏 机械通气 心肌梗死 心源性休克 治疗结果 

分 类 号：R541[医药卫生—心血管疾病]