28例心肌梗死后室间隔穿孔介入封堵患者主动脉内球囊反搏应用分析  

Application of intra-aortic balloon pump in 28 patients with post-myocardial infarction ventricular septal rupture

作　　者：陈同峰[1] 孙子瑞 蒋亚鹏 韩宇[1] 韩艳[1] 高传玉[1] 刘煜昊[1] CHEN Tongfeng;SUN Zirui;JIANG Yapeng;HAN Yu;HAN Yan;GAO Chuanyu;LIU Yuhao(Heart Center of Henan Provincial People’s Hospital,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Henan Key Laboratory of Coronary Heart Disease Control,Henan Research Center for Cardiovascular Epidemiology,Zhengzhou,450003,China)

机构地区：[1]河南省人民医院心脏中心,华中阜外医院,郑州大学华中阜外医院,河南省冠心病防治重点实验室,河南省心血管流行病学研究中心,郑州450003

出　　处：《临床心血管病杂志》2020年第5期423-428,共6页Journal of Clinical Cardiology

基　　金：2018年度河南省医学科技攻关计划联合共建项目(No:2018020439)。

摘　　要：目的:探讨主动脉内球囊反搏(IABP)的应用对心肌梗死后室间隔穿孔介入封堵患者血流动力学的影响。方法:连续入选2017年1月-2018年12月于我科介入封堵治疗的28例心肌梗死后室间隔穿孔患者,根据是否应用IABP分为IABP组(16例)及非IABP组(12例)。对比2组患者的临床资料及术中心导管数据,探讨IABP应用对血流动力学的影响。结果:非IABP组与IABP组梗死部位存在显著差异(P=0.048),而入院时收缩压、冠状动脉病变支数、罪犯血管、是否全闭、是否合并室壁瘤、急性心肌梗死至室间隔穿孔时间、穿孔部位、穿孔大小、心肌梗死至封堵天数、手术成功率等相比较未见明显差异。IABP组主动脉舒张末期压力、左室收缩压、左室舒张末期压力及左向右分流量均较非IABP组降低(均P<0.05)。2组主动脉舒张期峰值压力无显著差异(P=0.068)。结论:IABP可在不影响全身灌注的前提下,降低室间隔穿孔患者的左室后负荷,从而降低左室收缩压,减少左向右分流,进一步降低左心室前负荷,改善心功能。Objective:To investigate the hemodynamic influence of intra-aortic balloon pump(IABP)in patients with post-myocardial infarction ventricular septal rupture.Method:Twenty-eight patients with post-myocardial infarction ventricular septal rupture from January 2017 to December 2018 were divided into IABP group(n=16)and non-IABP group(n=12).The clinical and cardiac catheter data between the two groups were compared,the hemodynamic influence of IABP was investigated.Result:There was significant difference in infarction position between the two groups(P=0.048).At the same time,there was no significant difference in systolic pressure,number of coronary artery lesions,criminal vessels,completely closed or not,ventricular aneurysm or not,time from acute myocardial infarction to ventricular septal rupture,rupture position,perforation size,time from acute myocardial infarction to occlusion,and success rate of operation.The aortic end diastolic pressure,left ventricular systolic pressure,left ventricular end diastolic pressure,and left to right shunt volume were lower in IABP group than those in non-IABP group(all P<0.05).There was no significant difference in the peak aortic diastolic pressure between the two groups(P=0.068).Conclusion:IABP can reduce the left ventricular posterior load of patients with ventricular septal rupture without affecting systemic perfusion,thereby reduce the left ventricular systolic pressure,left-to-right shunt volume,and left ventricular anterior load,then improve the cardiac function.

关 键 词：室间隔穿孔 主动脉内球囊反搏 心导管 

分 类 号：R541.4[医药卫生—心血管疾病]