主动脉内球囊反搏术联合连续性肾脏替代疗法治疗急性心肌梗死后心源性休克的临床观察

Clinical observation on the intra-aortic balloon pump combined with continuous renal replacement therapy in the treatment of cardiogenic shock after acute myocardial infarction

目的观察主动脉内球囊反搏术(IABP)联合连续性肾脏替代疗法(CRRT)治疗急性心肌梗死(AMI)后心源性休克的临床效果。方法对43例AMI后出现心源性休克患者采用IABP联合CRRT治疗,观察患者治疗前后的心率、平均动脉压(MABP)、中心静脉压(CVP)、脑尿钠肽(BNP)、射血分数(EF)、心输出量(CO)、心脏指数(CI)、多巴胺用量以及pH、动脉血氧分压(PaO_2)、乳酸、尿素氮(BUN)、血肌酐、尿量、钠离子(Na^+)浓度等。结果 IABP联合CRRT治疗AMI后,患者的心率、CVP、BNP、CI、多巴胺用量、乳酸、BUN、血肌酐较治疗前显著降低,MABP、EF、CO、pH、PaO_2、尿量、Na+较治疗前显著升高(均P<0.01)。结论 IABP及CRRT联用治疗心肌梗死后心源性休克的临床效果明显。

Objective To observe the clinical effect of the intra-aortic balloon pump（IABP） combined with continuous renal replacement therapy（CRRT） in the treatment of cardiogenic shock after acute myocardial infarction（AMI）. Methods 43 cases with cardiogenic shock after AMI were treated with IABP combined with CRRT. The heart rate, mean arterial pressure（MABP）, central venous pressure（CVP）, brain natriuretic peptide（BNP）, ejection fraction（EF）, cardiac output（CO）, cardiac index（CI）, dopamine dosage and p H, arterial blood oxygen partial pressure（PaO_2）, lactic acid, blood urea nitrogen（BUN）, serum creatinine, urine volume and concentration of sodium（Na~＋） of the patients before and after the treatment were observed. Results After the treatment with IABP combined with CRRT, the patients had the heart rate, CVP, BNP, CI, dopamine dosage, lactic acid, BUN and serum creatinine significantly decreased compared with those before the treatment and had the MABP, EF, CO, p H, Pa O, urine volume and Na~＋ 2 significantly increased compared with those before the treatment（P〈0.01 for all）. Conclusion It is proved that the combination of IABP and CRRT in the treatment of cardiogenic shock after acute myocardial infarction has a clear clinical effect.