主动脉内球囊反搏在冠状动脉搭桥术围术期的积极应用

Active use of the intra-aortic balloon pump support in the perioperative coronary artery bypass grafting

目的探讨在冠状动脉搭桥术(CABG)围术期积极,预防性应用主动脉内球囊反搏(IABP)的效果。方法将35例冠状动脉搭桥手术同时需要接受IABP置入的患者根据置入的时机分为2组。组1(group-1)接受预防性的IABP置入,组2(group-2)在术中或术后接受紧急IABP的被动置入。比较两组患者术前的危险因素和冠脉病变严重程度,围手术期病死率、心肌梗死发生率、术后心功能不全的严重性和需要正性肌力药物辅助的程度。结果两组患者在心功能分级、心绞痛分级、术前药物治疗、左室收缩功能和急性心肌梗死这些方面的没有显著性差别。围手术期病死率在group-I是11.1%,group-2是34.6%,(P<0.01)。围手术期心肌梗死发生率在group-1是0,在group-2是50%,(P=0.013)。在需要正性肌力药物辅助,术后药物辅助的平均时间,术后正性肌力药物辅助时间超过12h,呼吸机辅助通气时间,IABP术后辅助时间以及平均术后在ICU的监护时间方面均有显著差异。结论 IABP的预防性置入能够降低围手术期的病死率和围手术期心肌梗死的发生率,减少对正性肌力药物的需要量和缩短在ICU的监护时间。

Objective To investigate the effect of intra-aortic balloon pump （IABP） inserted in the preventive condition in the high-risk coronary artery bypass patients. Methods To analyze 35 patients who received the CABG and needed the IABP support. They were divided into two groups. In group-1, it was of preventive use, and in group-2, in the emergency condition. It was compared in the postoperative mortality, myocardial infarction rate, inotropic drugs needed, IABP support time, ventilation assist time and ICU stay time. Results Postoperative mortality rate in group-1 was 11.1% ,and in group-2 was 34.6%, （P〈0.01） Myocardial infarction rate in group-1 was 0, and in group-2 was 50% （P=0.013） The needs of inotropic drugs and ICU stay time also had significant differences. Conclusion Preventive preoperative use of IABP can significantly decrease the post-operative mortality, myocardial infarction rate, the post-operative inotropie drugs needed, and shorten tire ICU stay.