不停跳冠状动脉旁路移植术前预防性应用主动脉内球囊反搏治疗急性心肌梗死  

The effect of preoperative use of intra-aortic balloon pump in acute myocardial infarction without cardiogenic shock patients undergoing off-pump coronary artery bypass grafting

作　　者：侯登榜 杨峰[1] 崔永超[1] 王金宏 江春景[1] 郝星[1] 刑智辰 徐博[1] 江瑜[1] 杨晓芳[1] 杜中涛[1] 邢家林[1] 侯晓彤[1] Hou Dengbang;Yang Feng;Cui Yongchao;Wang Jin- hong;Jiang Chunjing;Hao Xing;Xing Zhichen;Xu Bo;Jiang Yu;Yang Xiaofang;Du Zhongtao;Xing Jialin;Hou Xiao- tong(Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,100029

出　　处：《中华胸心血管外科杂志》2018年第7期409-412,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨不伴心源性休克（CS）的急性心肌梗死（AMI）患者接受不停跳冠状动脉旁路移植术（OPCABGG）前预防性应用主动脉内球囊反搏（IABP）的临床效果。方法回顾分析北京安贞医院2009年1月至2016年12月444例不伴cs的AMI患者接受OPCABGG临床资料，按照术前是否使用IABP分为IABP组（158例）和对照组（286例）。比较两组患者住院病死率及术后恢复情况。结果住院死亡22例（5．0％），倾向性匹配结果显示IABP组住院病死率较低（0对5．9％），差异有统计学意义（P=0．004）。IABP组机械通气和ICU停留时间分别为26（18，46）h和48（35，76）h，均较对照组23（15，42）h和26（20，69）h时间长，差异均有统计学意义（P〈0．05）。IABP组和对照组术后住院时间分别为9（7，12）天和10（7，14）天，差异无统计学意义（P〉0．05）。结论不伴cs的AMI患者OPCABGG前放置IABP辅助可降低住院病死率。Objective To evaluate the efficacy and safety of preoperative intra-aortic balloon pump （IABP） insertion in acute myocardial infarction（AMI） without cardiogenie shock （CS） patients receiving off-pump coronary artery bypass grafting （OPCABG）. Methods 444 consecutive AMI patients who underwent isolated OPCABG from January 2009 to December 2016 were enrolled. 158 patients who underwent preoperative IABP placement（IABP group） and the other of 286 patients who did not have IABP placement（ control group）. The in-hospital mortality rate, postoperative complications, mechanical ventilation time, ICU stay and hospital leugth were compared between the two groups. Results The overall mortality was 5.0%. 135 pairs of patients were matched. The preoperative IABP insertion showed benefits in postoperative survival rate compared with the control group（0 vs. 5.9% , P =0. 004）. However, patients with preoperative IABP were more likely to prolong duration of mechanical ventilation and ICU stay. The postoperative length of stay in hospital didn ＇ t show significant difference between the two groups. Conclusion Survival advantage was observed from preoperative IABP insertion in AMI patients without CS under- going OPCABG.

关 键 词：心肌梗死 不停跳冠状动脉旁路移植术 主动脉内球囊反搏 

分 类 号：R654.2[医药卫生—外科学]