主动脉内球囊反搏术在重症冠心病冠状动脉旁路移植围手术期中的应用

Intra-aortic balloon pump during the perioperative period of high-risk patients undergoing coronary artery bypass grafting:a clinical study

目的：探讨主动脉内球囊反搏术（IABP）在重症冠心病外科治疗围手术期应用的临床效果。方法：回顾自2005年7月-2014年1月，作者所在科室共手术治疗的重症冠心病65例，其中应用IABP34例，分为术前预防性应用IABP21例，术中或术后补救性应用IABP13例。结果：术前预防性应用IABP组围手术期死亡率为9％低于术中或术后补救性应用IABP组（31％），但差异未到达统计学显著水平（P=0．11）。两组IABP应用时间、体外循环时间、呼吸机辅助时间和ICU居留时间分别为：[（32±18）h vs．（55±22）h，P〈0．05]；[（122±37）min vs.（167±74）min，P〈0．05]；[（36±18）h vs.（60±22）h，P〈0．05]和[（52±13）h vs.（57±21）h，P〉0．05]。结论：术前预防性应用IABP辅助可降低重症冠心病患者围手术期死亡率到9％，明显减少IABP应用时间、体外循环时间、术后呼吸机辅助时间。在外科治疗重症冠心病时，IABP使用适应证应当适当放宽。

AIM： To study the clinical experience of intra-aortic balloon pump （IABP） during the perioperative period in high-risk patients undergoing coronary artery bypass grafting （CABG）. METHODS： A total of 34 extreme high-risk patients who underwent CABG combined with IABP support from July 2005 to January 2014 were analyzed retrospectively. Patients were divided into two groups： preoperative group （21 cases） and passive group （13 cases）. The rate of mortality, IABP support time, extracorporeal circulation （CPB） time, respiratory support time and ICU stay were compared between groups. RESULTS： Perioperative mortality in the preoperative group was lower than that in the passive group （6% vs. 31% ） without statistical significance （P = 0. 11 ）. Compared with those in the passive group, IABP support time and respiratory support time decreased significantly in preoperative group （ both P 〈 0. 05 ） [ （32 ± 18 ） h vs. （55 ± 22） h ; （ 122 ± 37 ） min vs. （ 167 ± 74） min ; （36 ± 18 ） h vs. （60 ± 22） h ]. No significant difference in ICU stay was found between groups （P 〉0. 05） [ （52 ± 13） h vs. （57 ±21） hi. CONCLUSION： For high-risk CABG patients, preoperative prophylactic application of IABP could decrease the perioperative mortality rate and reduce IABP support time, CPB time and respiratory support time. When high-risk patients with coronary disease are treated with CABG, the indications for IABP support should be expanded.