预防性置入主动脉内球囊反搏对老年急性心肌梗死并发心源性休克患者PCI治疗后心功能及预后的影响  

Influence of prophylactic intra-aortic balloon pump implantation on cardiac function and prognosis in elder patients with acute myocardial infarction complicated with cardiogenic shock after percutaneous coronary intervention

作　　者：蒙革[1] 吴伟[1] 石银华[1] 杨明华 王晓洁[3] MENG Ge;WU Wei;SHI Yin-hua;YANG Ming-hua;WANG Xiao-jie(Department of Cardiac Macrovascular Surgery,The First Hospital of Shijiazhuang,Shijiazhuang 050011,Chi⁃na;Department of Nursing,Hebei Province Chinese Medicine Hospital,Shijiazhuang 050011,China;De⁃partment 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]石家庄市第一医院心内科,石家庄050011

出　　处：《岭南心血管病杂志》2020年第1期19-23,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的观察预防性置入主动脉球囊反搏(intra-aortic balloon pump,IABP)对老年急性心肌梗死(acute myocardial infarction,AMI)并发心源性休克(cardiogenic shock,CS)患者经皮冠状动脉介入(percutaneous coro⁃nary intervention,PCI)治疗后心功能及预后的影响。方法回顾性分析2014年3月至2018年5月石家庄市第一医院行急诊PCI治疗的老年AMI并发CS患者87例,以IABP辅助下行PCI治疗的患者为IABP组(n=46),以未IABP辅助行PCI治疗的患者为对照组(n=41)。比较两组PCI治疗后30 d、术后1年左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDd)、左心室射血分数(left ventricular ejection fraction,LVEF)、N末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)及主要不良心血管事件。记录与IABP治疗有关的并发症。结果(1)IABP组术后30 d、术后1年LVEDd、LVEF、NT-proBNP等心脏指标均明显优于对照组,差异有统计学意义(P<0.05)。(2)IABP组用药种类、用药剂量低于对照组,差异有统计学意义(P<0.05)。(3)IABP组术后30 d严重心力衰竭、心源性猝死的发病率低于对照组,差异有统计学意义(P<0.05)。两组术后30 d非致死心肌梗死、再次PCI治疗及术后1年非致死心肌梗死、再次PCI治疗、严重心力衰竭、心源性猝死的发生率比较,差异无统计学意义(P>0.05)。(4)有12例(26.09%)发生了与IABP治疗有关的并发症,其中严重并发症3例(6.52%)。结论预防性置入IABP可有效改善老年AMI并发CS患者的心功能,并降低近期主要不良心血管事件的发生率,但并发症的发生率较高。Objectives To observe the influence of prophylactic intra-aortic balloon pump(IABP)implantation on car⁃diac function and prognosis in elder patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)after percutaneous coronary intervention(PCI).Methods The clinical data of 87 elder patients with AMI complicated with CS who had received emergency PCI in The First Hospital of Shijiazhuang from March 2014 to May 2018 were retrospectively reviewed.Patients accepted IABP support were in IABP group(n=46)and other patients not accepted IABP support were in control group(n=41).Left ventricular diastolic end internal diameter(LVEDd),left ventricular ejection fraction(LVEF),N-terminal B-type brain natriuretic peptide(NT-proBNP)and major adverse cardiovascular events(MACE)at 30 d,one year after PCI were compared between the two groups.The complications associated with IABP treatment were recorded.Results(1)Cardiac function indexes such as LVEDd,LVEF,NT-proBNP at 30 d,one year after PCI in IABP group were significantly better than those in control group,between which the differences were statistically significant(P<0.05).(2)The numbers of type and dose of drugs in IABP group were lower than those in control group(P<0.05).(3)The incidences of severe heart failure and sudden cardiac death at 30 d after PCI in IABP group were lower than those in control group,the differences were statistically significant(P<0.05).The incidences of non-lethal myocardial infarction,secondary PCI at 30 d after PCI and non-lethal myocardial infarction,secondary PCI,severe heart failure,sudden cardiac death at one year after PCI were no statistical significance(P>0.05).(4)The incidence of IABP complication was 26.09%(12 cases),and serious complication was 6.52%(3 cases).Conclusions The elder patients with AMI complicated with CS undergoing PCI can benefit from IABP support in terms of the cardiac function and recent major adverse cardiac events,but the incidence of IABP complication is high.

关 键 词：心肌梗死 主动脉内球囊反搏 心源性休克 经皮冠状动脉介入治疗 老年 

分 类 号：R542.22[医药卫生—心血管疾病]