主动脉内球囊反搏置入辅助急诊冠状动脉介入治疗老年急性心肌梗死伴心源性休克的分析  

Effect of intra-aortic ballon pump implantation for emergency percutaneous coronary intervention in old patients with acute ST-segment elevated myocardial infarction and cardiogenic shock

作　　者：祖晓麟[1] 张锋[1] 王成钢[1] 刘飞[1] 曾玉杰[1] ZU Xiaolin;ZHANG Feng;WANG Chenggang;LIU Fei;ZENG Yujie(Department of Emergency Cardiology,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-北京市心肺血管疾病研究所急诊危重症病房,100029

出　　处：《心肺血管病杂志》2018年第9期807-811,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:研究主动脉内球囊反搏术(IABP)辅助急诊经皮冠状动脉介入治疗(PCI)老年急性ST段抬高心肌梗死(ASTEMI)合并心源性休克(CS)患者的短期预后。方法:回顾性选择首都医科大学附属北京安贞医院心内科,自2015年1月至2016年12月,收治并应用IABP辅助急诊PCI治疗的STEMI合并CS的79例老年患者,同期选择未应用IABP辅助治疗的STEMI合并CS的75例老年患者作为对照组,比较两组术前、术中和术后情况的变化以及随访30 d时的病死率,并应用Kaplan-Meier生存分析评价两组的生存情况。结果:入选的154例患者中,男性85例,女性69例,平均年龄(69.4±9.3)岁,入院平均动脉压为(58.9±13.5)mmHg。两组间术前平均动脉压、CK-MB值、cTnI值、血肌酐、氧和指数、血肌酐、进门-球囊扩张时间、术后CK-MB和cTnI峰值、心电图ST段回落、完全血管化比例等,差异均有统计学意义(P<0.05)。两组患者血管活性药物使用时间、有创机械通气比例、住院时间、急性肾损伤、再发心肌梗死差异均有统计学意义(P<0.05)。随访30d时,死亡31例。Kaplan-Meier生存分析两组间的中位生存时间差异有统计学意义(P<0.05)。结论:IABP辅助PCI治疗老年ASTEMI急性冠状动脉综合征合并CS有助于改善短期患者的血流动力学。但IABP组患者基础心功能差,短期病死率高。因此需更多高质量、大规模的随机对照临床研究验证IABP辅助治疗老年ASTEMI的长期效果。Objective： To evaluate the short-term prognosis of intra-aortic ballon pump（ IABP）-supported emergency percutaneous coronary intervention（ PCI） in old patients with acute ST-segment elevated myocardial infarction（ ASTEMI） and cardiogenic shock（ CS） Methods： 79 ASTEMI and CS old patients received IABP supported PCI in Beijing Anzhen Hospital,Capital Medical University,from January 2015 to December2016 was involved. 75 old patients without IABP support was involved in control group. We compared the preprocedural,procedural and postprocedural clinical characteristics between groups. Meanwhile,we analyzed the short-term prognosis between groups. Furthermore,we used the Kaplan-Meier survival analysis to evaluate the survival benefit. Results： Among the 154 patients enrolled,there were 79 patients in the IABP group and 75 patients in the control group. There were 85 males and 69 females. The mean age was（ 69. 4 ± 9. 3） year-old,and mean arterial blood pressure（ MAP） was（ 58. 9 ± 13. 5） mm Hg. Basic characteristics,such as blood CKMB,cTnI level,creatinine level,oxygen index,MAP,vasopressor usage and percentage of CR were significantly different between groups（ P〈0. 05） Duration of vasopressor usage,and days stayed in hospital,acute kidney injury,and myocardial re-infarction were also significantly different between the two groups（ P〈0. 05）At 30-day follow-up,31 patients died. Kaplan-Meier analysis showed significantly different survival between groups（ P〈0. 05） Conclusion： IABP implanted was associated with improved survival benefit in old patients with ASTEMI and cardiogenic shock. However,elderly patients treated with IABP are usually with worse cardiac function and higher risk of mortality at 30 d follow-up,and more randomized controlled clinical trials are needed to confirm the long-term effects.

关 键 词：主动脉内球囊反搏术 急性ST段抬高心肌梗死 心源性休克 老年患者 预后 

分 类 号：R54[医药卫生—心血管疾病]