早期使用IABP对高危冠状动脉搭桥患者预后影响的研究

The clinical value of early applications of IABP in high-risk patients undergoing coronary artery bypass grafting

目的 探讨高危冠脉搭桥患者早期使用主动脉内球囊反搏（IABP）的效果，评价其对患者预后的影响，为IABP在冠脉外科的临床早期应用提供参考。方法回顾分析2008年1月至2012年12月1272例冠状动脉搭桥术患者资料，其中高危患者围手术期使用IABP196例。根据置入IABP的时机，将患者分为A、B两组。A组：104例，术前预防性使用IABP；B组：92例，术中、术后出现低心排、恶性心律失常、脱离体外循环困难或术后血流动力学不稳定应用IABP。分别统计两组患者术后院内死亡率、IABP使用时间、重症监护室（ICU）滞留时间、呼吸机使用时间、正性肌力药物使用时间。结果术后A、B两组患者院内死亡率分别为6．7％和27．2％，P〈0．025；IABP使用时间（51．36±31．28）h和（91．08±40．55）h，P=0．016；重症监护室（mu）滞留时间（72．41±39．56）h和（98．66±48．27）h，P=0．036；呼吸机使用时间（28．39±15．73）h和（86．34±30．08）h，P=0．001；正性肌力药物使用时间（58．65-＋30．56）h和（96．53-＋32．70）h，P=0．023。术前预防性使用IABP术后死亡率下降，IABP使用时间、ICU滞留时间、呼吸机使用时间、正性肌力药物使用时间均减少，差异有统计学意义。结论对于高危冠脉搭桥患者术前预防性使用IABP，可降低术后死亡率，减少正性肌力药物使用时间及IABP辅助时间，缩短呼吸机使用时间及ICU滞留时间，改善高危冠脉搭桥患者的预后。

Objective To analyze the clinical value and evaluate prognosis of early applications of the intraaortic ballon pump（IABP） in high-risk patients undergoing coronary artery bypass grafting. Aims to provide references for clinical early applications of IABP in coronary artery surgical department. Methods Reviewing clinical documentations of 1272 Coronary Artery Bypass Grafting operations （196 of which were high risk patients with IABP application during perioperative period） from Jan 2008 to Dec 2012. According to different application timing of IABP, I divided these cases into two groups-group A（10d cases）： apply before operation; group B（92 cases）： ap- ply during/after operation when there were some problems such as low cardiac output syndrome, malignant arrhyth- mia, difficult to weaning from cardiopulmonary bypass, as well as apply after operation with unstable hemodynamics. Recording some information separately of these two groups, including： mortality after operation （before leaving hospital）, application timing of IABP, resistance time in ICU, and the supporting time of mechanical ventilation and positive inotropic agents. Results Mortality after operation（before leaving hospital）： in group A was 6.7%, group B was 27.2%. Application timing of IABP was （51.36±31.28） and （91.08±40.55） in group A and B respectively（P= 0.016）. Supporting time of mechanical ventilation： （28.39±15.73 vs 86.34±30.08 ,P=0.001）. Supporting time of positive inotropic agents： （58.65±30.56 vs 96.53±32.70,P=0.023）. Conclusion The application of IABP for high risk patients of bypass operation before operation could reduce mortality after operation, reduce the necessary supporting time of positive inotropic agents and IABP application, reduce mechanical ventilation time, as well as improve the insistence time in ICU, and improve the prognosis of high risk patients undergoing coronary artery bypass grafting.