主动脉内球囊反搏置入时机对急性心肌梗死合并心原性休克患者预后的影响  

Impact of Intra-aortic Balloon Pump Implantation Timing on Prognosis of Patients With Acute Myocardial Infarction and Cardiogenic Shock

作　　者：郭超[1] 杨昊翰 王心宇 许浩博 袁建松[1] 李佳[1] 张峻[1] 吴元[1] 乔树宾[1] 杨伟宪[1] GUO Chao;YANG Haohan;WANG Xinyu;XU Haobo;YUAN Jiansong;LI Jia;ZHANG Jun;WU Yuan;QIAO Shubin;YANG Weixian(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京市100037

出　　处：《中国循环杂志》2022年第8期782-788,共7页Chinese Circulation Journal

基　　金：北京协和医学院“中央高校基本科研业务费”(3332020017)。

摘　　要：目的:探讨主动脉内球囊反搏(IABP)置入时机对急性心肌梗死(AMI)合并心原性休克(CS)患者预后的影响。方法:纳入2012年6月至2018年5月期间收入我院的AMI合并CS患者209例,其中置入IABP患者102例(置入IABP组)、未置入IABP患者107例(未置入IABP组)。为评估IABP置入与否以及置入时机不同(介入诊疗前置入和介入诊疗后置入)是否影响临床结局,对其临床资料进行回顾性分析。结果:(1)与未置入IABP组比,置入IABP组男性比例、ST段抬高型心肌梗死比例、接受急诊冠状动脉造影比例及简化急性生理学评分Ⅱ(SAPSⅡ)评分更高,既往经皮冠状动脉介入治疗术后、心房颤动、神志改变、罪犯血管为左前降支比例以及28 d病死率更低(P均<0.05)。Kaplan-Meier生存曲线显示,置入IABP可改善28 d生存率(46.1%vs.25.2%,P=0.003)。(2)在置入IABP的102例患者中,72例为介入诊疗前置入,30例为介入诊疗后置入。与介入诊疗前置入患者比,介入诊疗后置入患者血肌酐水平及SAPSⅡ评分更高(P均<0.05)。生存分析显示,介入诊疗前置入患者28 d生存率数值上高于介入诊疗后置入患者,但差异无统计学意义(52.8%vs.30.0%,P=0.118)。(3)回归分析表明,高龄(OR=1.015,95%CI:1.001~1.028,P=0.037)、神志改变(OR=2.709,95%CI:1.825~4.020,P=0.000)、PCI术后(OR=1.787,95%CI:1.180~2.705,P=0.006)为AMI合并CS近期预后的独立危险因素;接受急诊冠状动脉造影(OR=0.654,95%CI:0.435~0.984,P=0.042)、较高动脉血酸碱度(OR=0.064,95%CI:0.023~0.184,P=0.000)、较高的收缩压(OR=0.961,95%CI:0.948~0.973,P=0.000)为近期预后的独立保护因素。结论:置入IABP可改善AMI合并CS患者的近期预后,介入诊疗前置入有改善生存趋势,但并非28 d预后的独立保护因素。Objectives:To investigate the impact of different timing of intra-aortic balloon pump(IABP)support on prognosis of patients with acute myocardial infarction and cardiogenic shock.Methods:A total of 209 patients diagnosed with acute myocardial infarction and cardiogenic shock in our hospital from June 2012 to May 2018 were enrolled in our study.We collected the data from medical records and investigated their clinical manifestation and laboratory examination and IABP support,as well as 28-day mortality retrospectively.Results:102 out of 209 patients received IABP support.(1)Compared with patients without IABP support,those supported by IABP had higher incidence of male sex,ST-elevation myocardial infarction,emergency coronary artery angiography and higher simplified acute physiology score(SAPS)Ⅱscore,and lower incidence of atrial fibrillation,previous percutaneous coronary intervention(PCI),altered mental status and culprit artery of left anterior descending,as well as lower 28-day mortality.As is shown in Kaplan-Meier curve,IABP support could improve survival of this population(46.1%vs.25.2%,P=0.003).(2)Among 102 patients who received IABP support,the implantation was completed before PCI in 72 cases and after PCI in 30 cases.Patients with IABP implanted after PCI had higher levels of serum creatinine and SAPSⅡscore.Kaplan-Meier survival analysis showed that 28-day survival of the group with IABP implanted before PCI was numerically but not statistically better than that of those with IABP implanted after PCI(52.8%vs.30.0%,P=0.118).(3)Multivariate regression analysis indicated that advance age(OR=1.015,95%CI:1.001-1.028,P=0.037),altered mental status(OR=2.709,95%CI:1.825-4.020,P=0.000)and previous PCI(OR=1.787,95%CI:1.180-2.705,P=0.006)were the independent risk factors.Emergency coronary angiography(OR=0.654,95%CI:0.435-0.984,P=0.042),higher systolic blood pressure(OR=0.961,95%CI:0.948-0.973,P=0.000)and higher pH(OR=0.064,95%CI:0.023-0.184,P=0.000)were independent protective factors of short-term outcome.Conc

关 键 词：心原性休克 急性心肌梗死 主动脉球囊反搏 时机 

分 类 号：R54[医药卫生—心血管疾病]