主动脉内球囊反搏辅助介入治疗急性心肌梗死伴心力衰竭患者疗效评价

Evaluation of intra aortic balloon pump assisted percutaneous coronary intervention in patients with acute myocardial infarction and heart failure

目的评价主动脉内球囊反搏(IABP)辅助介入治疗急性心肌梗死诱发心力衰竭的效果及其对血浆超敏C反应蛋白(hs-CRP)、脑钠肽(BNP)等水平的影响。方法选取2013年1月—2015年12月南京大学医学院附属鼓楼医院心内科诊治急性心肌梗死伴心功能衰竭患者50例作为研究对象,随机数字表法分为对照组25例和治疗组25例,2组均予标准药物治疗及介入治疗,治疗组在常规治疗基础上联合使用IABP,在接受治疗前及治疗3 d后,检测血浆hs—CRP、BNP水平、心脏彩色超声测定左心室射血分数(LVEF)及左心室舒张末期内径(LVEDd)。结果治疗组心功能总有效率优于对照组(88.0%vs.64.0%,x^2=3.947,P=0.047);与治疗前比较,2组治疗后血浆hs—CRP、BNP均有明显下降(P<0.01),且治疗组下降较对照组更显著(P<0.05)。与治疗前比较,2组治疗后LVEDd均显著缩小,LVEF均显著升高(P<0.05),且治疗组改善均优于对照组(P<0.05)。2组均未出现严重不良反应。结论 IABP辅助介入治疗急性心肌梗死伴心力衰竭患者疗效肯定,可进一步降低hs-CRP及BNP水平,改善左室功能,可作为辅助治疗措施之一。

Objetc ive To evaluate the effect of intra aortic balloon pump （ IABP） in the treatment of acute myocardi-al infarction induced heart failure and its effect on the level of high sensitive C reactive protein （ hs-CRP） and brain natriuretic peptide （ BNP） in patients with acute myocardial infarction.Methods Fifty patients, who were in Killip Ⅲ or Ⅳ were en-rolled the study.All patients were divided intoIABP treatment group （25 cases） and control group （25 cases）.The levels of hs CRP and plasma BNP were evaluated, and left ventricular ejection function （LVEF ） and left ventricular end diastolic diam-eter （ LVEDd） was detected with cardiography.The indexes were re-evaluated in 72 hours after treatment.Results Cardiac function in the treatment group the total efficiency is better than the control group （88.0% vs.64.0%,χ2 =3.947, P =0.047）; compared with before treatment, after treatment of the 2 groups of hs-CRP and BNP were significantly decreased （P 〈0.01）, and the treatment group decreased more significantly than the control group （ P 〈0.05）.Compared with be-fore treatment, the 2 groups after treatment were significantly reduced LVEDd, LVEF were significantly elevated （ P 〈0.05）, and the treatment group was better than the control group （ P 〈0.05）.No serious adverse reactions occurred in the 2 groups.Conclusion IABP assisted interventional therapy in patients with acute myocardial infarction with heart failure pa-tients with curative effect, can further reduce the level of hs-CRP and BNP, improve the left ventricular function, can be used as one of the auxiliary treatment measures.