IABP预处理在合并左室收缩功能不全CTO病变介入治疗中的价值

IABP Preconditioning Effect during CTO Lesion Percutaneous Interventional Therapy of Patients with Impaired Left Ventricular Systolic Function

【目的】探讨在合并左室收缩功能不全慢性闭塞病变(CTO)PCI过程中主动脉内球囊反搏(IABP)预处理的临床意义。【方法】回顾性分析2004年到2011年南京市第一医院心内科,因合并左室收缩功能不全CTO患者而行PCI及IABP治疗的患者63例,按照IABP置入时间分组为PCI术前IABP预处理组和PCI术后IABP组。记录两组患者的基线临床资料,比较两组患者术中靶病变成功血运重建率,无复流发生率,PCI相关心肌梗死发生率,术后一年内全因死亡率。【结果】两组的靶病变血运重建率IABP预处理组为75.2%,术后IABP组为63.2%(P>0.05);IABP预处理组无复流发生率为16.3%,术后IABP组无复流发生率为42.1%(P<0.05);PCI相关心肌梗死发生率IABP预处理组为75.6%,术后IABP组为52.6%(P<0.05);术后一年内全因死亡率分别为:IABP预处理组为18.6%,术后IABP组为31.6%(P>0.05)。【结论】在合并左室收缩功能不全CTO病变介入治疗中,IABP预处理较术后IABP能显著减少术中无复流发生率,显著减轻术后PCI相关心肌梗死发生率,对靶病变血运重建率无显著影响,对一年内全因死亡率无显著影响。

[ Objective] To explore the clinical preconditioning effect of IABP during PCI for patients with CTO lesion accompanied with left ventricular systolic dysfunction. [Method] From 2004 to 2011, retrospective analysis for 63 patients with CTO lesion accompanied with left ventricular systolic dysfunction who underwent PCI and IABP in Department of Cardiology. All patients was divided into two groups, preoperative IABP group and post operative IABP group, according to the IABP implementing time. Both group basic clinical data were registered, and the target vessel opening ratio, non-reflow phenomenon ratio, PCI related myocardial infarction incidence, one year all-cause mortality after operation were registered and compared between the two groups. [ Result ] When compared with post operative IABP group, the preoperative group had no significant difference in basic clinical data, target vessel opening ratio and one year all-cause mortality. But when it comes to the non-reflow phenomenon ratio, the PCI related myocardial infarction incidence, the preoperative group had a significant difference compared to post operative group, which showed respective novel ratio as 16.3% to 42.1% （P 〈 0.05） and 75.6% to 52.6% （P 〈 0.05）. [Conclusion] In the peri-PCI operation period, preconditioning IABP before operation could lessen non-reflow phenomenon ratio and PCI related myocardial infarction incidence siKnificantlv, wile could not lower the target vessel openin~ ratio and one year all-cause mortality.