主动脉内球囊反搏在急性前壁ST段抬高型心肌梗死合并心源性休克患者中的疗效观察  

Intra-aortic balloon pump therapy for anterior ST-elevation myocardial infarction complicated by cardiogenic shock: an observational cohort study

作　　者：周阔[1] 吕树铮[1] 戴敬[1] 田晋帆 崔孔勇 闫云峰[1] 陈凌霄 秦政[1] ZHOU Kuo;LYU Shuzheng;DAI Jing;TIAN Jinfan;CUI Kongyong;YAN Yunfeng;CHEN Lingxiao;QIN Zheng(Department of 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心内科,100029

出　　处：《心肺血管病杂志》2020年第10期1163-1168,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：心血管疾病精准医学北京实验室(PXM2017_014226_000037);“十二五”科技支撑计划(2011BAI11B05)。

摘　　要：目的:评估主动脉内球囊反搏(IABP)在急性前壁ST段抬高型心肌梗死(STEMI)合并心源性休克(CS)患者治疗中的应用价值。方法:连续入选北京安贞医院2006年1月至2018年12月间,因急性STEMI发生CS的患者271例,其中IABP组155例,对照组116例,比较两组患者短期和长期预后。结果:与对照组相比,IABP组30 d死亡率显著降低(47.1%vs. 62.1%,P=0.019),Kaplan-Meier生存曲线示IABP组患者30 d累计生存率始终高于对照组(Log-Rank检验P=0.006),亚组分析提示对于年龄<60岁、男性、无高血压病史、收缩压<80 mmHg(1 mmHg=0.133 kPa)的患者,应用IABP有预后良好的趋势。随访12个月时,IABP组和对照组的全因死亡率分别为51.7%和71.8%(P=0.002),其他心血管不良事件发生率差异无统计学意义(21.4%vs. 20.7%,P=1.000)。结论:在急性STEMI合并CS的患者中,IABP能有效降低死亡率、改善预后。Objective: This study aimed to explore the efficacy of intra-aortic balloon pump(IABP) therapy in patients presenting with anterior ST-elevation myocardial infarction(STEMI) complicated by cardiogenic shock(CS). Methods: A retrospective study of 271 consecutive patients with CS after STEMI in the anterior wall was conducted between January 2006 and December 2018, including 155 patients in the IABP group and 116 patients in the control group. Short-term and long-term prognosis were evaluated by 30-day and 12-month all-cause mortality, respectively. Results: At 30 days, all-cause mortality was significantly reduced in the IABP group as compared to its control(47.1% vs. 62.1%, P=0.019). Kaplan-Meier survival curves displayed that IABP group had consistently higher cumulative survival rate than control group(P=0.006 by Log-Rank test). Subgroup analyses showed there were positive trends of prognoses in patients aged less than 60 years old, male, no history of hypertension and systolic blood pressure less than 80 mmHg. At 12-month follow-up, the rates of all-cause mortality in the IABP group and control group was 52.5% vs. 74.1%(P=0.002), there were no apparent difference in the incidence of other adverse cardiovascular events(21.4% vs. 20.7%, P=1.000). Conclusions: The combination of IABP use is effective in reducing all-cause mortality, which significantly improves short-term and long-term outcomes in patients with anterior STEMI complicated by CS.

关 键 词：主动脉内球囊反搏 急性ST段抬高型心肌梗死 前壁 心源性休克 

分 类 号：R54[医药卫生—心血管疾病]