IABP支持下急诊PCI治疗急性心肌梗死并心源性休克的疗效观察

Therapeutic Effect of Emergency Percutaneous Coronary Intervention Accessory Intra-aortic Balloon Pump in Patients with Acute Myocardial Infarction Combined with Cardiogenic Shock

目的:探讨主动脉内球囊反搏(IABP)支持下急诊经皮冠状动脉介入(PCI)治疗急性心肌梗死(AMI)并心源性休克(CS)的临床疗效。方法:选取急诊PCI治疗的AMI并CS的患者47例,24例接受IABP支持下急诊PCI治疗的患者为治疗组,23例直接急诊PCI治疗的患者为对照组。治疗一周后,检测两组患者平均动脉压(MAP)、尿量、心率、肺动脉楔压(PCWP)、心脏指数(CI)、左室射血分数(LVEF)、及N末端血浆B型尿钠肽前体(NT-pro BNP)指标的变化,多巴胺、速尿和硝酸酯类用量的比较及死亡率比较。结果:治疗前两组各项观察指标差异无统计学意义(P>0.05);治疗后两组各项观察指标与治疗前比较,差异均有统计学意义(P<0.05);治疗后两组各观察指标差值比较,差异有统计学意义(P<0.05);治疗组多巴胺、速尿用量少于对照组,差异有统计学意义(P<0.05);治疗组硝酸酯类用量少于对照组,但差异无统计学意义(P>0.05);治疗后两组死亡率比较,差异有统计学意义(P<0.05)。结论:急性心肌梗死并心源性休克患者在IABP支持下行急诊PCI,可明显改善患者的冠状动脉血流,改善心肌的血供,改善心功能,降低病死率。

Objective：To evaluate the therapeutic effect of emergency percutaneous coronary intervention accessory intra-aortic balloon pump in patients with acute myocardial infarction combined with cardiogenic shock.Methods：Clinical data of AMI combined with cardiogenic shock from 47 patients were collected.Twenty-four cases of treatment group were performed with emergency PCI with accessory IABP,and twenty-three cases of control group were performed with emergency PCI.One week ago,the mean arterial pressure（MAP）,urine volume,heart rate,pulmonary capillary wedge pressure（PCWP）,cardiac index（CI）,left ventricular ejection fraction（LVEF）,NT-pro BNP was observed and compared between the two groups.The dosage of dopamine,furosemidum and Nitrates and the mortality was compared between two groups.Results：Before the treatment,the items of two groups had no significantly differences（P0.05）;the items of two groups both had significantly differences after the treatment compared with before treatment（P0.05）;after the treatment,the differentials of the items of the two groups had significantly differences（P 0.05）.The dosage of dopamine and furosemidum was lower in the treatment group than that of the control group,and had significantly differences（P0.05）;the dosage of Nitrates was lower in the treatment group than that of the control group,but had no significantly difference（P 0.05）.The mortality of two groups had significantly differences（P0.05）.Conclusions：The emergency PCI with accessory IABP therapy in the patients with acute myocardial infarction combined with cardiogenic shock can significantly increase coronary perfusion and improve myocardial blood supply,thereby improve cardiac function,reduce the mortality.