急性心肌梗死合并心源性休克或血流动力学紊乱患者应用主动脉内球囊反搏术后影响临床疗效的危险因素分析

Analysis of influencing factors of intra-aortic balloon counter pulsation on patients with cardiac shock or hemodynamic disorder after acute myocardial infarction

目的探讨急性心肌梗死（AMI）合并心源性休克（CS）或血流动力学紊乱患者应用主动脉内球囊反搏术（IABP）辅助治疗后,影响临床疗效的危险因素。方法回顾性分析广州军区广州总医院68例因AMI合并CS或血流动力学紊乱应用IABP辅助治疗的患者,根据其临床转归分为好转、死亡两组。对两组的性别、年龄、高血压、糖尿病、吸烟、高脂血症、既往冠心病史、入院时心率、入院时收缩压、入院时舒张压、病变血管支数、发病至行IABP术时间、TIMI血流、罪犯血管14项进行Logistic回归分析。结果本研究的死亡率为47.06%,所有危险因素中,罪犯血管是影响临床疗效的独立危险因素（P=0.015）,其余危险因素均未影响预后（P〉0.05）。罪犯血管组间比较显示,前降支与其他罪犯血管间差异有统计学意义（OR 0.047,95%CI 0.004~0.547,P=0.015）。结论罪犯血管是AMI合并CS或血流动力学紊乱应用IABP辅助治疗后影响临床疗效的危险因素。前降支病变患者应用IABP辅助治疗后可降低住院期间死亡率,左主干、右冠状动脉病变患者应用IABP辅助治疗后未能降低住院期间死亡率。

Objective To explore the influencing factors of clinical outcomes in patients with cardiac shock（ CS） or hemodynamic disorder after acute myocardial infarction（ AMI） with application of intra-aortic balloon counter pulsation（ IABP） adjuvant therapy. Methods Retrospective analysis of 68 patients with CS or hemodynamic disorder after AMI with application of IABP adjuvant therapy was made.The patients were devided into the surivival group（ n = 36） and the deceased group（ n = 32） according to their clinical outcome. Logistic regression analysis of sex,age,co-morbidities of hypertension,diabetes,smoking,and hyperlipidemia,history of coronary heart disease,heart rate,systolic / diastolic blood pressure,lesion blood vessel counts,time from pathogenesis to IABP placement,TIMI flow grades,culprit vessel was done between the two groups. Results The mortality rate of our study was 47. 06%. Of all the risk factors,culprit vessel is the only independent risk factor that affect the clinical prognosis（ P = 0. 015）,but other risk factors do not affect the clinical prognosis（ P 〉 0. 05）. Compared the culprit vessels,anterior descending branch was statistically different in correlation from other culprit vessels（ OR 0. 047,95% CI 0. 004-0. 547,P = 0. 015）. Conclusions Culprit vessel is the risk factor that affects clinical prognosis of patients with CS or hemodynamic disorder after AMI with application of IABP adjuvant therapy. Application of IABP adjuvant therapy in patients with anterior descending branch lesions can reduce the in-hospital mortality,but cannot reduce the in-hospital mortality in other calprit vessel lesions including left main or RCA lesions.