主动脉球囊反搏在老年急性冠状动脉综合征中的应用及对预后的影响

Application of aortic balloon counterpulsation in elderly patients with acute coronary syndrome and its effect on their prognosis

目的探讨主动脉球囊反搏(IABP)在老年急性冠状动脉综合征(ACS)患者治疗中的应用及预后以及影响预后的因素。方法回顾性分析2005年1月～2011年1月住院置入IABP的ACS患者76例,根据年龄分为<75岁组40例,≥75岁组36例,分析其住院期间及1年的预后。结果 76例患者中,院内死亡22例,占28.9%,1年死亡29例,占38.2%,2组院内病死率比较差异无统计学意义(P>0.05),≥75岁组较<75岁组1年病死率明显升高(P<0.05)。Kaplan-Meier生存曲线显示,与<75岁组比较,≥75岁组患者1年生存率明显降低(P=0.009)。Cox比例风险回归模型分析显示,年龄偏大、LVEF降低、PCI术后TIMI血流0～1级降低是1年死亡的独立危险因素。结论联合IABP治疗的ACS患者预后良好。高龄、LVEF低、PCI术后TIMI血流降低,是应用IABP的ACS患者1年死亡的独立危险因素。

Objective To study the application of intra-aortic balloon counterpulsation（IABP）in elderly patients with acute coronary syndrome（ACS） at the age 〈75 years or 〈75 years and its effect on their prognosis. Methods Clinical data about 76 ACS patients who underwent IABP placement from January 2005 to January 2011 in our hospital were retrospectively analyzed. The patients were divided into 〈75 years old group（n=40） and 〈75 years old group（nz36）. Their prognosis in hospital and 1 year after discharge was analyzed. Results Of the 76 ACS patients,22 （28.9%） died in hospital and 29 （38.2%） died 1 year after discharge. No significant difference was found in hospital mortality between the two groups（P〈0.05）. The mortality was significant- ly higher in 〈75 years old group than in 〈75 years old group 1 year after discharge（P〈0.05）. Kaplan-Meier survival analysis showed that the 1-year survival rate was significantly lower in 75 years old group than in 〈75 years old group（P=0. 009）. Cox proportional hazard regression analysis displayed that high age,low LVEF and TIMI flow （0--1） after PCI were the independent risk factors for death 1 year after discharge. Conclusion The prognosis of ACS patients is good after IABP treatment. Advanced age, low LVEF and TIMI flow after PCI are the independent risk factors for death of ACS patients 1 year after discharge.