冠状动脉粥样硬化性心脏病伴轻度左心功能不全患者围术期应用主动脉内球囊反搏早中期结果分析

Early and mid-term results of perioperative intra-aortic balloon pumping in patients with coronary artery disease and mild left ventricular dysfunction

目的研究分析冠状动脉粥样硬化性心脏病(CAD)伴轻度左心功能不全患者接受冠状动脉旁路移植术(CABG)围术期应用主动脉内球囊反搏(IABP)的早中期结果,为其围术期应用IABP提供临床依据。方法回顾性分析1995年5月至2014年7月在解放军总医院心血管外科接受CABG的CAD伴轻度左心功能不全患者。按围术期是否应用IABP分为IABP组和非IABP组。比较两组术前左心功能、欧洲心脏手术风险评估系统(Euro SCOREⅡ)预测死亡率与在院死亡率。对在院死亡的主要危险因素进行logistic回归分析。比较两组患者围术期及术后近远期生存率和主要不良心脑血管事件(MACCEs)免除率。结果共有480例患者纳入研究,IABP组44例,非IABP组436例。IABP组术前左心室射血分数低于非IABP组,Euro SCOREⅡ预测死亡率高于非IABP组。术后两组在院死亡率无差异。Logistic回归分析结果显示IABP植入、近期心肌梗死、术前危急状态、重症监护室(ICU)天数、术后室颤是在院死亡的独立危险因素。两组患者中期生存率无统计学差异,IABP组MACCEs发生率随着时间推移逐渐高于非IABP组。结论围术期应用IABP、近期心肌梗死、术前危急状态、术后室性心律失常、ICU天数为接受CABG的CAD伴轻度左心功能不全患者在院死亡的独立危险因素,其中围术期应用IABP是降低在院死亡率保护因素,达到应用指征时积极应用能取得良好的近中期效果,但其积极应用同时增加了患者气管插管时间、ICU天数和近中期MACCEs发生率。

Objective To analyze the early and mid-term outcomes of perioperative application of intra-aortic balloon pumping（ IABP） in coronary artery disease（ CAD） patients with mild left function insufficiency undergoing coronary artery bypass grafting（ CABG） in a single centre. Methods Clinical data of patients with CAD and mild left ventricular dysfunction who underwent CABG between May 1995 to July 2014 in our department were retrospectively analyzed. The patients were divided into IABP group and non IABP group according to the perioperative application. Preoperative left ventricular ejection fraction（ LVEF）,Euro SCORE Ⅱ predicted mortality and in-hospital mortality were noted. Logistic regression analysis was performed to reveal the major risk factors of death.The postoperative 7-year survival rate and freedom from MACCEs were compared between the two groups. Results A total of 480 patients were included in the study,44 patients in IABP group and 436 patients in non-IABP group. Preoperative LVEF in IABP group was lower than that in non-IABP group. The Euro SCORE Ⅱ predicted mortality of IABP group was higher than non-IABP group.There was no difference in in-hospital mortality between the two groups. Logistic regression analysis showed that perioperative IABP implantation,recent myocardial infarction（ MI）,preoperative critical status,days of ICU stay,postoperative ventricular fibrillation（ VF） were the independent risk factors of in-hospital death. Perioperative IABP implantation is associated with reduced in-hospital mortality. There was no difference in the mid-term survival rate between the two groups. But the incidence of MACCEs in IABP group was higher than non-IABP group. Conclusions Perioperative IABP implantation,recent MI,preoperative critical status,postoperative VF,ICU days were the independent risk factors for CAD with mild left ventricular dysfunction patients undergoing CABG. Perioperative IABP implantation is a protective factor in reducing in-hospital mortality. Application of IABP may achieve good early and mid-term effects,but it may also increase the ventilation time,ICU days and the incidence of mid-term MACCEs.