急性心肌梗死合并心源性休克病人行主动脉内球囊反搏术联合经皮冠状动脉介入术的临床疗效分析

Clinical analysis of intra-aortic balloon bump combined with percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock

目的探讨急性心肌梗死合并心源性休克病人行主动脉内球囊反搏术(IABP)联合经皮冠状动脉介入术(PCI)的临床疗效。方法回顾性分析收治的急性心肌梗死合并心源性休克病人,行急诊PCI治疗病人106例,按照是否采用IABP支持,分为对照组(未行IABP)和观察组(行IABP)。比较两组病人术后2 d时血液动力学变化,3 d时心肌酶学变化,术后3个月时左室射血分数(LVEF)以及左室舒张末径(LVEDD)的变化,3个月内两组病人主要心血管事件发生情况。结果观察组术后2 d的血液动力学指标显著优于对照组(P<0.05);观察组术后3 d时心肌酶学显著低于对照组(P<0.05);观察组LVEF在术后3个月显著高于对照组(P<0.05),而LVEDD在术后3个月显著优于对照组(P<0.05)。观察组病人术后3个月时死亡例数显著低于对照组(P<0.05),两组间再发心肌梗死以及血栓形成无显著性差异(P>0.05)。结论 IABP联合PCI治疗急性心肌梗死合并心源性休克能有效的改善血液动力学指标,减轻心肌细胞损伤,增强心功能,降低病死率。

Objective To explore the clinical effect of intra-aortic balloon bump combined with percutaneous coronary intervention in patients with acute myocardial infarction and cardiogenic shock.Methods Retrospectively analyzed106patients with acute myocardial infarction and cardiogenic shock from December2014to June2016underwent emergency percutaneous coronary intervention.According to the use of intra-aortic balloon bump(IABP),the patients were divided into the control group(no IABP)and the observation group(IABP).Compared the changes of hemodynamics after2days,the changes of myocardial enzyme after3days,the changes of left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)at3months after treatment between the two groups.The incidence of major cardiovascular events within3months of two groups were recorded and compared.Results The hemodynamic indexes of observation group were significantly superior to that of control group after2days treatment(P<0.05).The myocardial enzymology on observation group was significantly lower than control group after three days treatment(P<0.05).The observation group left ventricular ejection fraction(LVEF)after3months surgery were significantly higher than that of control group(P<0.05),while the left ventricular end-diastolic diameter(LVEDD)after3months surgery were significantly better than that of control group(P<0.05).The observation group of death patients with postoperative3months were significantly lower than that of control group(P<0.05).There was no significant difference on recurrence of myocardial infarction and thrombosis between the two groups(P>0.05).Conclusion Intra-aortic balloon bump combined with percutaneous coronary intervention in acute myocardial infarction with cardiogenic shock can effectively improve hemodynamic parameters,reduce myocardial injury and enhance cardiac function and reduce mortality.