急性心肌梗死合并室间隔穿孔主动脉内球囊反搏治疗脱机影响因素及护理策略分析  

Influencing Factors and Nursing Strategies for Discontinuation of Intra-aortic Balloon Pump Treatment in Patients with Acute Myocardial Infarction with Ventricular Septal Rupture

作　　者：董丹萍[1] 王梦圆 罗晓亮 杨洋 刘永[1] 李国庆[1] 热衣拉·买买提 DONG Danping;WANG Mengyuan;LUO Xiaoliang;YANG Yang;LIU Yong;LI Guoqing;Reyila·MaiMaiti(Department of Cardiology,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Department of cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]新疆维吾尔自治区人民医院心脏与泛血管医学诊疗中心,乌鲁木齐830000 [2]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,北京100037

出　　处：《中国分子心脏病学杂志》2024年第5期6387-6391,共5页Molecular Cardiology of China

基　　金：新疆维吾尔自治区人民医院院内项目基金(20210241)。

摘　　要：目的探讨急性心肌梗死(acute myocardial infarction,AMI)合并室间隔穿孔患者主动脉内球囊反搏(intra-aortic balloon pump,IABP)治疗脱机影响因素及相对应的护理策略。方法回顾性分析2009年1月至2023年10月中国医学科学院阜外医院和新疆维吾尔自治区人民医院冠心病重症监护病区收治的74例AMI合并室间隔穿孔且行IABP治疗患者的临床资料,对脱机成功组(34例)和失败组(40例)进行组间比较分析,采用多因素logistic回归分析脱机影响因素。结果与脱机失败组比较,脱机成功组体重更大[(71.99±11.77)kg比(66.10±11.20)kg,P=0.031],就诊时随机血糖水平偏低[(8.25±4.41)mmol/L比(10.84±4.66)mmol/L,P=0.017],左心室舒张末内径轻度增大[(54.59±5.59)mm比(49.50±6.06)mm,P=0.001],接受外科/介入封堵治疗比例更高(82.35%比5.00%,P=0.001)。多因素logistic回归分析结果显示,左心室舒张末内径(HR=1.305,95%CI:1.046~1.627,P=0.018)和接受外科/介入封堵治疗(HR=366.736,95%CI:20.200~6658.037,P=0.001)是成功撤出IABP辅助循环的预测因素。结论左心室舒张末期内径和接受外科/介入封堵治疗是AMI合并室间隔穿孔IABP辅助循环治疗患者成功撤除的潜在预测指标。Objective To explore the influencing factors and corresponding nursing strategies for the discontinuation of intra-aortic balloon pump(IABP)treatment in patients with acute myocardial infarction(AMI)complicated with ventricular septal rupture(VSR).Methods Patients diagnosed of AMI complicated with VSR from January 2009 to October 2023 in Fuwai Hospital and People′s Hospital of Xinjiang Uygur Autonomous Region were collected.A total of 74 patients were included in the study.Clinical features,hospital related examination results,treatment and prognosis of these patients were analyzed statistically between successful removal of IABP group(n=34)and the failed group(n=40),Multivariate logistic regression was used to evaluate the independent risk factors of successful removal of IABP assisted.Results Compared with the group of patients failed to removal of IABP assisted,the group of patients successfully weaned have a larger body weight[(71.99±11.77)kg vs(66.10±11.20)kg,P=0.031],lower random blood glucose levels at visit[(8.25±4.41)mmol/L vs(10.84±4.66)mmol/L,P=0.017],a larger left ventricular end diastolic diameter[(54.59±5.59)mm vs(49.50±6.06)mm,P=0.001],and a higher proportion of patients who received surgical/interventional occlusion treatment(82.35%vs 5.00%,P=0.001).Multivariate regression Logistic analysis suggests that left ventricular end diastolic diameter(HR=1.305,95%CI:1.046-1.627,P=0.018)and receiving surgical/interventional treatment(HR=366.736,95%CI:20.00-6658.037,P=0.001)are predictive factors for successful detachment from IABP assisted circulation.Conclusion Left ventricular diastolic diameter and receiving surgical/interventional treatment are potential predictive indicators for successful removal of IABP assisted circulation therapy in acute myocardial infarction with ventricular septal rupture.

关 键 词：室间隔穿孔 主动脉内球囊反搏 护理 

分 类 号：R473.5[医药卫生—护理学]