主动脉内球囊反搏对急性心肌梗死合并心源性休克患者的疗效观察

Efficacy of intra-aortic balloon pump in patients with acute myocardial infarction complicated with cardiogenic shock

目的探讨主动脉内球囊反搏(IABP)在急性心肌梗死(AMI)合并心源性休克患者中的应用价值。方法 2007年5月至2009年3月给予13例AMI合并心源性休克的患者急诊行IABP循环支持治疗,以同时期同一疾病未经IABP治疗的15例患者作为对照组进行比较,观察其循环复苏前后的基础心率、血压(收缩压、舒张压、平均动脉压)、心功能、尿量、多脏器衰竭、恶性心律失常、30d病死率等指标的变化。结果 2组间年龄、性别、院前时间、冠状动脉病变支数、再发心梗次数及IABP治疗前心功能分级(Killips分级)、收缩压、舒张压差异无统计学意义,而患者的心功能恢复情况、30d病死率、恶性心律失常发生率、多器官功能衰竭发生率、循环支持药物的应用等有显著性差异(P<0.01),IABP治疗组较对照组明显获益(P<0.01)。与治疗前比较,IABP循环支持治疗后患者收缩压、舒张压、平均动脉压、心功能分级、尿量明显提高,心率明显下降(P<0.01)。结论对AMI合并心源性休克患者尽早进行IABP治疗具有明显的循环支持疗效,可以为下一步的治疗争取时间并能明显减少并发症、降低病死率。

Objective To observe the efficacy of intra-aortic balloon pump （IABP） in the patients with acute myocardial infarction （AMI） complicated with cardiogenic shock. Methods Twenty-eight patients with AMI complicated with cardiogenic shock were separated into 2 groups, 13 patients receiving IABP support treatment and 15 patients not. Heart rates, blood pressure, heart function （Killip＇s grade）, urine volume, multiple organ function failure （MODF）, malignant arrhythmia, and 30 days’mortality were measured. Results The differences in age, sex, time of chest pain, the coronary arteries involved, heart function before treatment of IABP and blood pressure between 2 groups were not significant,while the differences in heart function, malignant arrhythmia, 30 days＇ mortality, multiple organ function failure and application of dopamine between 2 groups were significant. Conclusions The early use of IABP in patients with cardiogenic shock after AMI can improve survival rate and reduce complications, and gain valuable time to prepare for next treatment.