急性心肌梗死伴心泵衰竭患者行主动脉内球囊反搏术围术期血液动力学变化

Hemodynamic changes of AIM patients with left ventricular pump failure treated with IABP in the perioperative period

目的研究急性心肌梗死(AMI)伴心泵衰竭(CS)患者行主动脉内球囊反搏术(IABP)围手术期内血液动力学变化,以期为临床治疗提供参考。方法选取2013年1月至2015年1月间入院诊治的急性心肌梗死合并心泵衰竭的患者52例。根据其治疗方法分为观察组(28例)与对照组(24例)。观察组应用介入手术联合主动脉内球囊反搏术,对照组单纯应用介入手术治疗。应用多参数血流动力学检测仪观察术前、术后1 h及术后24 h两组患者的血流动力学变化。同时分析两组并发症的发生情况及手术指标。结果两组患者术前血流动力学指标,均无显著差异。观察组术后1 h血流动力学各项指标均显著好转(P<0.05),且术后24 h各项血流动力学指标显著优于对照组(P<0.05)。观察组CS抢救成功率、尿量、肺水肿发生率、总住院时间、住院期间病死率均显著优于对照组(P<0.05),但在PCI成功率方面两组并无显著差异。结论对急性心肌梗死伴心泵衰竭的患者行主动脉内球囊反搏术可有效改善患者围术期血流动力学,降低住院期间病死率,且手术安全性相对较高。

Objective To study the acute myocardial infarction（ CS） with heart pump failure（ AMI） patients with intra-aortic balloon counterpulsation（ IABP） around the hemodynamic changes during surgery,in order to provide a reference for clinical treatment. Methods Fifty two acute myocardial infarction patients with left ventricular pump failure from January 2013 to January 2015 were selecte. They were treated with intra-aortic balloon counterpulsation（ IABP）,and according to the treatment method,they were divided into trail group（ 28 cases） and control group（ 24 cases）. Trail group patients were treated with interventional surgery combined with IABP,control group patients were treated with interventional surgery. Hemodynamic changes of two group patients were detected by Multiparameter hemodynamic detectorat at different times. Preoperative and postoperative 1 h and 24 h after operation. The occurrence of complications of two group patients were compared. Results There is no significant difference for preoperative hemodynamic between two groups. 1h after blood flow dynamics of the indicators in the observation group were significantly improved（ P〈0. 05）,and 24 h after the hemodynamic parameters significantly better than the control group（ P〈0. 05）.Survival rate,urine,pulmonary edema,incidence of hematoma,hospitalization,died during hospitalization in CS observation group were significantly better than those of the control group（ P〈0. 05）,but no significant difference in the PCI success rate. Conclusion Acute myocardial infarction patients with left ventricular pump failure underwent aortic balloon counterpulsation can improve hemodynamic perioperative period to reduce mortality during hospitalization and surgical safety is relatively high.