延长主动脉内气囊反博术在急性心肌梗死合并泵衰竭中的研究

Study of prolonged intra-aortic balloon pumping in patients with pump failure complicated by acute myocardial infarction

目的评价急诊主动脉内气囊反博术(Intra-aortic balloon pumping,IABP)对急性心肌梗死合并泵衰竭患者循环支持治疗的疗效及延长IABP循环支持治疗的安全性和有效性。方法临床确诊为急性心肌梗死合并泵衰竭患者共39例,均给予急诊IABP循环支持治疗,同时行经皮冠状动脉介入治疗(PCI)。72小时后将符合IABP脱机标准患者随机分为两组,A组停用IABP循环支持;B组继续维持IABP循环支持7天。观察患者IABP治疗前后左室功能恢复状况及两组安全性和有效性的差别。结果①IABP循环支持治疗后较治疗前患者平均动脉压(MAP)、心脏指数(CI)、左室射血分数(LVEF)、血氧饱和度(SaO2)明显提高,肺毛细血管楔压(PCWP)、心率(HR)明显下降。②住院期间延长IABP治疗组(B组)CI、LVEF增加,PAWP降低,与对照组(A组)比较两组间差异有统计学意义(P<0.05)。③随访1年,B组患者6分钟步行试验、LVEF值优于A组患者,两组间差异有统计学意义(P<0.05)。室壁瘤发生率和总死亡率无差别。结论①IABP对急性心肌梗死并发泵衰竭在急性期有明显的循环支持治疗效果。②延长IABP循环支持时间对急性心肌梗死并发泵衰竭患者左心功能的改善有益。

Objective： To evaluate the efficacy of intra-aortic balloon pumping （IABP） support in patients with pump failure complicated by acute myocardial infarction（AMI） and the safety as well as the efficacy of prolonged use of IABP support. Methods： Thirty-nine patients with pump failure complicated by AMI were treated with percutaneous coronary in- tervention （PCI） which was supported by IABP. After 72 hours, supported by IABP, the patients who attained the criteria of IABP weaning were randomly divided into two groups. The using of IABP was ceased in the control group while IABP continued in the case group for 7 days. Both the functional restoration of left ventricle and the differences in the safety as well as the efficacy of the two groups before and after the treatment were analyzed. Results ： 1 ） With the IABPsupporting mean arterial pressure （MAP）, cardiac index （CI）, left ventricle ejection fraction （LVEF） and arterial oxygen saturation （SaO2 ） of the patients significantly elevated whereas pulmonary capillary wedge pressure （PCWP） and heart rate（HR） de- creased. 2） The CI, LVEF and PCWP in the prolonged IABP group were significantly improved than those in the control groups in the duration of hospital stay（ P 〈 0.05）. 3 ） After the one year follow-up visitation, the six minutes＇walking test and LVEF were significantly improved in the case group, which were better than those in the control group （ P 〈 0. 05）. No significant differences were noted between the two groups in the incidence rate of ventricular aneurysm and total ratio of deaths. Conclusion ： 1 ） IABP has significant therapeutic efficacy on the patients with pump failure complicated by AMI. 2） It can improve the function of left ventricle of patients with pump failure complicated by AMI by means of prolonging the time of IABP supporting.