高危冠状动脉搭桥患者应用主动脉内球囊反搏治疗的时机选择

The timing of application of the IABP in high-risk patients undergoing coronary artery bypass grafting

目的总结高危冠状动脉搭桥患者应用主动脉内球囊反搏（IABP）的经验，探讨预防性置入IABP和被动紧急置入IABP对临床预后的影响，为高危患者置入IABP的时机提供合理依据。方法回顾性分析2002年1月至2009年2月1632例冠脉搭桥术或冠状动脉搭桥同期其他心脏手术等高危冠状动脉搭桥患者应用IABP资料，共128例，分预防性置入IABP组（A组）68例和被动紧急置入IABP组（B组）60例。A组为左主干病变（冠脉狭窄〉90％）且无右冠脉保护、心功能低下（左室射血分数〈35％）、顽固性心绞痛保守治疗无效、冠状动脉搭桥同期其他心脏手术；B组为术中循环不稳定、心功能低下脱离体外循环困难或术后血流动力学不稳定、心功能降低等。分析A、B两组术后临床效果，比较两组术后死亡率、并发症发生率、术后心血管活性药物应用、IABP使用时间、术后机械通气时间、住ICU时间。结果A组术后死亡率和并发症发生率为8．8％和4．4％，B组为50．0％和14．9％；术后平均正性肌力药物辅助时间：（57．63±33．66）h比（94．63±62．72）h，P=0．027；平均IABP使用时间：（54．75±37．68）h比（93．12±52．21）h，P=0．015；机械通气时间：（31．83±14．71）h比（89．34±35．17）h，P=0．001；平均住ICU时间：（76.35±47．27）h比（102．41±44．12）h，P=0．032，差异有统计学意义（P〈0．05）。结论对于高危冠状动脉搭桥患者，术前预防性置入IABP能减少正性肌力药物辅助时间，缩短IABP辅助时间、机械通气时间和住ICU时间，降低术后死亡率。

Objective To compare the clinical outcome effect between the intraaortic balloon pump（IABP） inserted in the preoperative preventive condition and in the emergency condition for the patients with high risk undergoing coronary artery bypass grafting （CABG）. Methods To review one hundred and twenty eight patients who received the CABG and contemporary need of IABP support were divided into two groups depended on the IABP established time from Jan 2002 to Feb 2009 in our hospital, sixty eight patients preoperative group （A group）, including coronary artery stenosis （LM〉90%）, myocardial dysfunction （EF〈35%）,intractable angina, CABG complicating other cardiosurgery. Sixty patients were inserted at the emergency condition（B group）, including hemodynamics instability or the discontinuance of extracorporeal circulation difficult in operating, myocardial dysfunction after operation. Items of comparison between two groups were the post-operative mortality, severity of postoperative myocardial dysfunction and cardiovascular drug consumed quantity, IABP support time, ventilation assist time and intensive care unit （ICU） stay time. Results Postoperative mortality（8.8%） and complication rate （4.4%） in A group were lower than those in B group （50.0%, 14.9%）. Simukaneity,the difference in postoperative periods of both groups in cardiovascular drug support time： （57.63±33.66）h vs（94.63±62.72）h,P=0.027, IABP support time ： （54.75 ±37.68）h vs （93.12 ±52.21 ）h,P =0.015,ventilation assist time ： （31.83 ±14.71 ）h vs （89.34±35.17）h,P=0.001, and in the ICU stay time ： （76.35±47.27）h vs （ 102.41±44.12）h,P=0.032, were significant （P〈0.05）. Conclusion Patients with high risk undergoing coronary artery bypass grafting were preventively inserted IABP in pre-operation can significantly decrease the quantity of cardiovascular drug and the pest- operative mortality, moreover, IABP support time, ventilation assist time, the ICU stay time is shortened.