主动脉内球囊反搏在老年冠状动脉移植术中的应用

The application of the intra-aortic balloon pump in elderly patients undergoing coronary artery bypass grafting

目的:评价主动脉内球囊反搏在老年冠状动脉移植术中的应用。方法:回顾性分析2006年5月至2009年2月在我院行冠状动脉移植手术应用主动脉内球囊反搏(IABP)辅助的老年(≥65岁)患者资料。其中男性77例,女性34例,平均年龄(69.9±3.8)岁。结果:所有患者中非体外循环冠状动脉移植术79例,体外循环冠状动脉移植术32例。IABP术前放置32例(28.82%),术中/术后放置79例(71.17%),主要并发症有:急性肾功能损伤(45.05%),感染(35.14%)和二次气管插管(12.61%)等。术后住院死亡30例,病死率27%。术前置入IABP的患者病死率(15.63%)明显低于术中或术后置入IABP的患者病死率(31.65%,P=0.004)。患者置入IABP时间不同,其术后是否二次气管插管、是否发生急性肾功能损伤差异有统计学意义(P<0.05)。多因素回归分析二次气管插管(OR=165.850,95%CI7.110～386.557,P=0.001)、感染(OR=20.911,95%CI2.940～148.710,P=0.002)和急性肾功能损伤(OR=12.557,95%CI2.935～53.716,P=0.001)是住院死亡的独立危险因素。结论:对于行冠状动脉移植术的老年患者,IABP是安全且行之有效的辅助循环手段之一,在本组研究中,术前放置IABP组患者的病死率显著低于术中/术后放置IABP组患者的病死率,故应积极预防和控制围术期并发症的发生,以降低患者的病死率。

Objective：To evaluate the effect of the intra-aortic balloon pump （ IABP） in elderly patients undergoing coronary artery bypass grafting （CABG）. Methods：The clinical data of 111 elderly patients （age 65） undergoing CABG with application of IABP from May 2006 to February 2009 were retrospectively analyzed. Results：Seventy-nine patients performed off-pump CABG,32 patients performed on-pump CABG. IABP was inserted before CABG in 32 patients（28. 82% ） and was used intra-or post-operation in 79 patients. （71. 17%） Main complications were acute kidney injury（45. 05%）,infection（35. 14%） and re-intubation （12. 61%）. The postoperative hospital mortality was 27%. The mortality of patients in whom the IABP were inserted before CABG was significantly higher than that of whom IABP were used intraor postoperation （15. 63% vs 31. 65%,P =0. 004）. Postoperation reintubation and acute kidney injury were significantly different among patients with different insert time of IABP. The independent risk factors of mortality were re-intubation（ OR = 165. 850,95% CI 7. 110-386. 557,P = 0. 001）,infection （ OR = 20. 911,95% CI 2. 940148. 710,P = 0. 002） and acute kidney injury（OR = 12. 557,95% CI 2. 935-53. 716,P = 0. 001） by logistic regression analysis. Conclusion：IABP therapy is a safe and effective mode of circulation support for elderly patients undergoing CABG. The mortality of patients in whom the IABP were inserted before CABG was significantly higher than that of whom IABP were used intra-or post-operation. Postoperative complications should be prevented and controlled to improve hospital survival.