主动脉球囊反搏术辅助下非体外循环冠状动脉旁路移植术临床疗效分析

Clinical curative effect of intra-aortic balloon counterpulsation assisted off-pump coronary artery bypass grafting in unprotected left main coronary artery patients

目的观察和分析无保护左主干（ULMCA）患者行非体外循环冠状动脉旁路移植术（OPCABG）高危患者应用主动脉内球囊反搏（IABP）的治疗效果。方法回顾性分析自2008年2月~2013年10月收入延安大学附属医院心血管科通过冠脉造影证实为ULMCA患者28例,根据ULMCA病变及临床情况分为IABP组以及非IABP组（对照组）。两组患者均行OPCABG术,术后监测两组患者有创动脉收缩压（SABP）、有创平均动脉压（MABP）、机械辅助通气时间、住ICU时间、IABP辅助时间、正性肌力药物辅助时间等。术后3个月复查心脏超声心动图检测左心室射血分数（LVEF）。结果两组即刻手术成功率均为100%。与非IABP组比较,IABP组患者术后SABP〔（92±4） mmHg vs.（83±4） mmHg,P〈0.01〕、MABP〔（78±5） mmHg vs.（60±6） mmHg,P〈0.01〕均显著高于非IABP组;机械辅助通气时间、住ICU时间、正性肌力药物辅助时间较非IABP组短。两组患者均按时随访,随访时间均为3个月。术后3个月时心脏超声心动图提示IABP组LVEF显著高于非IABP组〔（48±4）% vs.（38±4）%,P〈0.01〕。结论对无保护左主干行OPCABG术的患者,术前置入IABP且把握好撤机时机可显著提高手术效果。

AIM To investigate the therapeutic effect of intra-aortic balloon counterpulsation （IABP） assisted off-pump coronary artery bypass grafting （OPCABG） in unprotected left main coronary artery （ULMCA） patients. METHODS We retrospectively investigated 28 ULMCA patients （15 males and 13 females） diagnosed by coronary angiography in our hospital from February 2008 to October 2013. The patients were divided into two groups according to the ULMCA conditions： IABP group [ n = 15, nine males and six females, aged （62. 5 ±7.7） years] and non-IABP group [ n = 13, 6 males and 7 females, aged （60. 3 ± 8.5 ） years ]. Patients in both groups underwent off-pump coronary artery bypass grafting （OPCABG） and their invasive arterial systolic blood pressure （SABP）, invasive mean arterial blood pressure （MABP）, mechanical assisted ventilation time, ICU stay time, IABP assisted time, and the time of taking positive inotropic drugs were compared post-operation. Left ventricular ejection fraction （LVEF） was examined by ultrasonic cardiogram after 3 months. RESULTS ： Immediate operation success rate in both groups was 100%. Compared with those in non-IABP group, SABP and MABP in IABP group were significantly higher [ （92. 5 ± 3.7） mmHg vs. （ 82.7 ± 4. 2 ） mmHg, P = 0. 000 ] ; [ （77.6± 5.3 ） mmHg vs. （60. 5 ± 6. 0） mmHg, P = 0. 000 ]. Assisted mechanical ventilation time, ICU stay time, time using positive inotropic drugs in IABP group were shorter than those in non-IABP group. Patients in both groups were followed-up for 3 months. Ultrasonic cardiogram showed that LVEF in IABP group was higher than in non-IABP group after 3 months （48.5% ± 4.2% vs. 37.8% ± 3.8% , P = 0. 000）. CONCLUSION For ULMCA patients undergoing OPCABG, proper use of IABP can reduce the risk and enhance the effect of the operation, promote recovery, improve cardiac function and reduce complications and perioperative mortality.