急性心肌梗死合并室间隔穿孔患者行主动脉内球囊反搏的疗效  

Therapeutic efficacy of intra-aortic balloon pump usage in acute myocardial infraction patients complicated with ventricular septal rupture

作　　者：周迟 蒋建刚[1] Zhou Chi;Jiang Jiangang(Department of Cardiology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China)

机构地区：[1]华中科技大学同济医学院附属同济医院心血管内科,武汉430030

出　　处：《中国心血管杂志》2021年第2期123-126,共4页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金(81800336、81873505)。

摘　　要：目的探讨应用主动脉内球囊反搏(IABP)治疗急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的疗效。方法回顾分析华中科技大学同济医学院附属同济医院2009年1月至2019年5月收治的24例AMI合并VSR患者的临床资料。按照治疗方式分为联合治疗组(10例)和单纯药物治疗组(14例)。单纯药物治疗组仅给予单纯药物治疗,联合治疗组在药物治疗的基础上早期联合应用IABP支持。观察所有患者的临床特点、穿孔发生的时间、大小和位置。比较血流动力学改善率(心率和血压的变化)和治疗前后的心功能、住院期间并发症和死亡率情况。结果两组的年龄、男性比例、既往史等基线资料均无统计学差异(均为P>0.05)。联合治疗组使用IABP 1 d后收缩压明显改善,治疗3 d后收缩压、舒张压、心率和射血分数均显著改善(均为P<0.05)。住院期间两组的并发症发生率相似(P>0.05),但联合治疗组死亡率明显低于单纯药物治疗组(40.0%比85.7%,χ^(2)=5.486,P=0.019)。多因素logistic回归分析发现IABP的使用可显著降低患者的死亡率(OR=0.039,95%CI:0.002~0.713,P=0.029)。结论对AMI合并VSR患者,应尽早联合应用IABP支持,可稳定患者的血流动力学,降低死亡率。Objective To investigate the efficacy of intra-aortic balloon pump(IABP)usage in the therapy of acute myocardial infarction(AMI)patients complicated with ventricular septal perforation(VSR).Methods The clinical data of 24 AMI patients complicated with VSR in Tongji Hospital,Tongji Medical Collage of Huazhong University of Science and Technology from January 2009 to May 2019 were reviewed and analyzed.Patients were divided into the combine-treated group(10 cases)and the drug-treated group(14 cases)according to the therapeutic strategies.The drug-treated group only received drug therapy,and the combine-treated group received early IABP support and drug therapy.The clinical characteristics,and the time,size,location of VSR were observed.Hemodynamic improvement(changes in heart rate and blood pressure)was compared between groups.Cardiac function,in-hospital complications and mortality were evaluated.Results There were no statistically significant differences in age,male proportion and previous history between the two groups(all P>0.05).In the combine-treated group,the systolic blood pressure was obviously improved at 1 d after IABP use,and the systolic blood pressure,diastolic blood pressure,heart rate and ejection fraction were obviously improved at 3 d after therapy(all P<0.05).The incidence of complications during hospitalization was similar between the two groups(P>0.05),but the mortality rate of the combine-treated group was markedly lower than that of the drug-treated group(40.0%vs.85.7%,χ^(2)=5.486,P=0.019).Multivariate logistic regression analysis result showed that the usage of IABP was associated with significantly reduced mortality(OR=0.039,95%CI:0.002-0.713,P=0.029).Conclusions For AMI patients complicated with VSR,IABP support could be used as early as possible to stabilize the hemodynamics and even reduce mortality.

关 键 词：急性心肌梗死 室间隔穿孔 主动脉内球囊反搏 

分 类 号：R54[医药卫生—心血管疾病]