主动脉内球囊反搏在慢性肾功能不全冠状动脉粥样硬化性心脏病患者介入治疗中的应用  

Clinical application of intra-aortic balloon pump during percutaneous coronary intervention in patients with coronary heart disease associated with chronic renal dysfunction

作　　者：吴伟[1] 蒙革[1] 冯海合 石银华[1] 李宇 杨明华 殷珊珊[3] 王晓洁[4] WU Wei;MENG Ge;FENG Hai-he;SHI Yin-hua;LI Yu;YANG Ming-hua;YIN Shan-shan;WANG Xiao-jie(Cardiac Macrovascular Surgery,The First Hospital of Shijiazhuang,Shijiazhuang 050011,China;Department of Nursing,Hebei Province Chinese Traditional Medicine Hospital,Shijiazhuang 050011,China;Department of Anesthesiology,The First Hospital of Shijiazhuang,Shijiazhuang 050011,China;Department of Cardiology,The First Hospital of Shijiazhuang,Shijiazhuang 050011,China)

机构地区：[1]石家庄市第一医院心脏大血管外科,石家庄050011 [2]河北省中医院护理部,石家庄050011 [3]石家庄市第一医院麻醉科,石家庄050011 [4]石家庄市第一医院心内科,石家庄050011

出　　处：《岭南心血管病杂志》2019年第5期566-570,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨主动脉内球囊反搏(intra-aortic balloon pump,IABP)在慢性肾功能不全冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中的应用效果及安全性。方法回顾性分析石家庄市第一医院2013年1月至2018年6月慢性肾功能不全冠心病行PCI治疗并IABP治疗的患者93例(R组),以同期单纯冠心病肾功能正常行PCI治疗并IABP治疗的患者102例为对照组(C组)。收集2组患者入院时的一般临床资料以及总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、平均动脉压(mean arterial pressure,MAP)、肌钙蛋白I(cardiac troponin I,cTnI)、肌酸激酶同功酶(creatine kinase isoenzyme,CK-MB)等指标。比较2组治疗前后血肌酐(creatinine,Cr)及肾小球滤过率(glomerular filtration rate,GFR)。记录2组患者冠状动脉血管病变、PCI治疗和IABP植入情况、院内病死率、出院后1年病死率。分析影响2组患者死亡的危险因素。结果R组合并糖尿病患者比例、合并陈旧性心肌梗死患者比例及cTnI、CK-MB浓度明显高于C组,差异有统计学意义(P<0.05)。2组间治疗前后Cr、GRF浓度比较,差异有统计学意义(P<0.05);2组内治疗前后Cr、GRF浓度比较,差异无统计学意义(P>0.05)。2组冠状动脉病变、IABP相关并发症发生率比较,差异无统计学意义(P>0.05)。R组置入支架数、IABP运转时间明显高于C组,差异有统计学意义(P<0.05)。Logistic多因素回归分析显示,左主干及多支病变、置入支架数为院内及出院后1年死亡的独立危险因素(OR=2.35,95%CI:1.68~39.54,P=0.001)。结论IABP辅助治疗应用于慢性肾功能不全冠心病患者PCI治疗中具有一定的可行性及安全性。Objectives To explore the clinical effect and safety of intra-aortic balloon pump(IABP)after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD)associated with chronic renal dysfunction.Methods The clinic data of 93 patients with CHD associated with chronic renal dysfunction received PCI + IABP (R group)in The First Hospital of Shijiazhuang from January 2013 to June 2018 were reviewed retrospectively,and 102 simple CHD patients without renal dysfunction received PCI+IABP in the same period were in C group.General clinical data and total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),mean arterial pressure(MAP),cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB)at admission were collected in the two groups.Serum creatinine(Cr)and glomerular filtration rate(GFR)before and after treatment were compared between the two groups.Coronary angiopathy,PCI operation,IABP implantation,nosocomial mortality,1-year mortality after discharge were recorded in the two groups.The risk factors of death in the two groups were analyzed.Results Diabetes mellitus ratio,old myocardial infarction ratio and concentrations of cTnI,CK-MB in R group were significantly higher than those in C group(P<0.05).There were statistically significant differences in concentration of Cr and GRF between the two groups before and after treatment(P<0.05),and no statistically significant differences in concentration of Cr and GRF within the two groups before and after treatment(P>0.05).There was no statistically significant difference in incidence of coronary lesions and IABP-related complications in the two groups(P> 0.05),and the number of stent implantation and IABP operation duration in R group were significantly higher than those in C group(P<0.05).Logistic multivariate regression analysis showed that numbers of left main coronary artery lesion and multiple lesions,number of stents were independent risk factors for death in hospital and 1 year after discharge(O

关 键 词：冠状动脉疾病 主动脉内球囊反搏 慢性肾功能不全 血管成形术 经腔 经皮冠状动脉 

分 类 号：R541.4[医药卫生—心血管疾病]