主动脉球囊反搏辅助治疗急性心肌梗死合并心源性休克患者的预后分析

Analysis on the prognosis of aortic balloon counterpulsation in the adjuvant treatment of acute myocardial infarction complicated with cardiogenic shock

目的探讨主动脉球囊反搏(intra-aortic balloon pump,IABP)辅助冠状动脉介入(percutaneous coronary intervention,PCI)治疗急性心肌梗死(acute myocardial infarction,AMI)合并心源性休克(cardiac shock,CS)患者的临床特点与预后。方法回顾性分析大连市中心医院2013年1月~2017年1月共90例AMI合并CS的患者,应用IABP辅助行PCI治疗,根据出院转归分为死亡组30例和生存组60例。结果 (1)平均发病至入院时间(7.57±3.19)h,死亡组较生存组明显延迟(P<0.05)。(2)死亡组与生存组比较,女性和糖尿病比例大、年龄大、入院时收缩压低,差异有统计学意义(P<0.05)。死亡组PCI治疗后心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级TIMI 3级比率及PCI术前气管插管呼吸机辅助通气比率低于生存组,差异有统计学意义(P<0.05)。两组患者在罪犯血管、入门-球囊时间方面无统计学差异(P>0.05)。死亡组在住院期间临床事件发生率(床旁血滤、急性肾衰竭)较生存组高,差异无统计学意义(P>0.05)。结论 IABP辅助PCI治疗AMI合并CS,并不能明显降低早期院内死亡率。

Objective To investigate the clinical features and prognosis of intra-aortic balloon pump（IABP） combined with adjuvant percutaneous coronary intervention（PCI） in the treatment of acute myocardial infarction（AMI） complicated with cardiac shock（CS）. Methods A total of 90 patients with AMI complicated with CS in Dalian Central Hospital from January 2013 to January 2017 were retrospectively analyzed. IABP combined with adjuvant PCI was applied. According to the discharge outcomes, the patients were divided into two groups： 30 cases in death group and 60 cases in survival group. Results（1） The duration from onset to admission was（7.57±3.19） hours, and the death group was significantly delayed compared with the survival group（P〈0.05）.（2） Compared with the survival group, the proportion of female and diabetes in the death group was larger, the age was higher, and the systolic pressure was lower on admission. The differences were statistically significant（P〈0.05）. In the death group, the ratio of TIMI grade 3 by thrombolysis in myocardial infarction（TIMI） test after treatment of PCI and the ratio of ventilator-assisted ventilation of tracheal intubation before PCI were lower than those in the survival group, and the difference was statistically significant（P〈0.05）. There was no statistically significant difference between the two groups in the criminals＇ blood vessels and the introductory-balloon time（P〉0.05）. The incidence rate of clinical events（bedside filter, acute renal failure） in the death group during hospi talization was higher than that in the survival group, with no statistically significant difference（P〉0.05）. Conclusion IABPassisted PCI in the treatment of patients with AMI complicated with CS does not significantly reduce early hospital mortality.