主动脉内球囊反搏在急性心肌梗死合并心源性休克中的应用

Effect of Intra-Aortic Balloon Pump with Acute Myocardial Infarction Companied by Cardiogenic Shock

目的探讨主动脉内球囊反搏(IABP)在介入治疗急性心肌梗死合并心源性休克患者中的作用。方法回顾性分析19例急性心肌梗死合并心源性休克患者IABP辅助治疗的临床效果。结果19例患者IABP使用时间平均为93.6 h,其中13例成功地进行介入治疗(13/14,92.9%),2例成功接受外科搭桥,2例在等待搭桥术过程中死亡,1例药物治疗。三支血管病变10例(占52.6%),二支病变(前降支+回旋支)1例(占5.3%),单纯前降支5例(占26.3%),单纯左主干2例(占10.5%)。住院期间总死亡4例(4/19,21.1%),介入治疗病人死亡2例(2/14,14.3%),未介入或搭桥治疗死亡2例(2/3,66.7%)。结论IABP支持下急诊行冠脉介入治疗,可显著提高急性心肌梗死伴心源性休克患者的生存率,未能介入治疗和左主干病变经介入治疗后血液动力学仍不稳定者应及时采取外科搭桥治疗。

Objective To assess the clinical effect of intra-aortic balloon pump （IABP） in patients with cardiogenic shock due to acute myocardial infarction（AMI）. Methods A retrospective study was carried out in 19 AMI patients with cardiogenic shock treated with IABP and acute percutaneous coronary intervention （PCI）. Results All patients were treated with IABP support with a mean of 93.6 h. The PCI success rate was 92.9% （13/14） and the mortality rate of PCI patients was 14.3% （2/14）. The overall in-hospital mortality rate was 21.1% （4/19）. The mortality of non-revascularization patients was 66.7% （2/3）. Conclusion IABP and acute PCI can improve haemodynamic stability and decrease cardiogenic shock inpatient mortality significantly. The prognosis is bad in patients with left main arterial or multivascular disease without revascularization therapy.