主动脉内球囊反搏在高危急性心肌梗死直接PCI中的应用

The use of intra aortic balloon pump in primary percutaneous coronary intervention in high risk patients with acute myocardial infarction

目的探讨合并左心衰竭、心源性休克高危急性心肌梗死(AMI)患者在主动脉内球囊反搏(IABP)支持下行直接PCI的临床疗效。方法88例合并左心衰竭、心源性休克的高危AMI患者,左心衰竭50例,心源性休克38例,在IABP支持下行直接PCI。观察住院期间心脏事件、临床疗效和出院时的左心室射血分数(LVEF)。结果术前安置好IABP,冠状动脉造影示梗死相关血管血流全部TIMI0级。1例心源性休克患者术中因室颤死亡,其余成功实施PCI,手术成功率98.9%,术后81例(93.1%)血流TIMI3级,6例(6.9%)血流TIMI2级。IABP持续使用36￣154(52.6±29.8)h。多支病变者在术后3￣7d再次PCI。住院总生存率70.5%,左心衰竭组80%,心源性休克组57.9%。出院前测平均LVEF40%,左心衰竭组48%,心源性休克组38%。结论合并左心衰竭、心源性休克的高危AMI患者,及时行IABP支持下直接PCI,可明显降低死亡率,改善心脏功能。

Objective To investigate the clinical effect of using intra attic balloon pump （IABP） in primary percutaneous coronary intervention （PCI） on pump failure or cardiagenic shock complicating acute myocardial infarction （AMI）. Methods 88 high risk patients with AMI were studied, 50 of whom had pump failure ,38 of whom had cardigenic shock. PCI was performed with IABP support. The cardiac events and left ventricular ejection fraction （LVEF） were record during hospitalization. Results The successful rate of PCI with IABP support was 98.9%.IABP was used for an average time of 52.6±29.8 hrs. The general survival rate during hospitalization was 70.5%, 80% in pump failurepatients and 57.9% in cardiogenic shock patients. The average LVEF was 40% （48% in pump failure patients, 38% in cardiogenic shock patients）. Conclusion The combination of early IABP support and successful PCI can improve survival rate and heart function in AMI patients complicated with pump failure or cardiogenie shock.