主动脉内球囊反搏术在急性心肌梗死治疗中的应用和对近期预后的影响

Use and short-term outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction

目的了解急性心肌梗死(AMI)治疗中主动脉内球囊反搏术(IABP)的应用、并发症发生率和对近期预后的影响。方法单中心注册研究。连续入选2004年10月至2008年7月间,就诊于北京安贞医院28病房置入IABP的所有AMI患者。结果806例AMI患者中,共有121例(15.0%)置入IABP。最常见指征为高危冠状动脉(冠脉)造影和(或)PCI术中和术后提供血流动力学支持(66.9%)和心源性休克(26.4%)。IABP置入成功率为98.3%,平均使用时间为34±16h。严重并发症发生率为0%。所有患者均进行了冠脉造影,93.4%在出院前施行了冠脉血管重建。总住院死亡率为13.2%(其中心源性休克患者34.4%),住院死亡率因置入IABP指征不同和施行冠脉血管重建与否存在很大差异。结论IABP可成功应用于AMI的多种高危状况并提供必要的血流动力学支持,严重并发症罕见,联合冠脉血管重建治疗可降低死亡率。

Objective To examine current use, associated complications, and short-term outcomes in patients with acute myocardial infarction （AMI） requiring intra-aortic balloon pump （IABP） counterpulsation. Methods A single-centre registry was conducted between October 2004 and July 2008. Data were collected from 121 consecutive AMI patients treated with IABP counterpulsation at the 28th Division of Beijing Anzhen Hospital. Results Among 806 patients with AMI, IABP counterpulsation was employed in 121 patients. Placement of an IABP was indicated for hemodynamie support during high-risk catheterization and/or angioplasty （ 66. 9% ） and cardiogenic shock （ 27. 3% ）. Balloon insertions were successful in 98.3% of patients and duration of mean use was 34. 2 ＋ 16. 2 hours. No major IABP complications occurred in all the patients. Diagnostic catheterization was performed in all the patients inserted with IABP, and 93.4% underwent coronary revascularization before hospital discharge. The total in- hospital mortality was 13.2% （34. 4% in patients with cardiogenic shock ） and varied markedly by indication and use of revascularization procedures. Conclusion IABP counterpulsation may be successfully employed for a wide variety of conditions in the AMI setting, providing significant hemodynamic support with rare major complications in a high-risk patient population. IABP counterpulsation may reduce mortality in patients with AMI undergoing reperfusion therapy.