主动脉内球囊反搏在高危冠状动脉旁路移植患者应用时机的探讨

The timing of intra-aortic balloon pump in high-risk patients undergoing off-pump coronary artery bypass grafting

目的:探讨不同时期置入主动脉内球囊反搏(IABP)对高危冠心病患者行非体外循环冠状动脉旁路移植术(OPCAB)的安全性、围手术期各指标的影响以及危险因素分析。方法:回顾本中心心脏外科自2015年1月至2018年8月,586例OPCAB患者中78例(13. 3%)高危冠心病患者应用IABP辅助治疗的时机及临床效果。根据置入IABP的时机,将患者分为预防应用组、紧急置入组两组。预防应用组:42例(53. 8%),术前对冠心病高危患者预防性用IABP辅助;紧急置入组:36例(46. 2%),OPCAB术中或术后因循环不稳定紧急置入IABP。对比两组患者使用IABP时间、ICU时间、术后住院天数、并发症、死亡率等指标。结果:两组患者术中旁路移植的桥血管数目及并发症发生率差异无统计学意义(P>0. 05)。预防应用组患者IABP应用时间、机械通气时间及ICU停留时间均明显短于紧急置入组(P<0. 05)。术前预防应用组患者围手术期病死率(4. 8%)较紧急置入IABP患者(13. 9%)明显减低(P<0. 05)。结论:对于高危冠心病患者术前预防性应用IABP能缩短IABP使用及ICU停留时间,降低术后30 d病死率,预防性应用IABP对高危OPCAB患者是安全有效的,再次置入IABP是高危OPCABG患者短期死亡的危险因素。

Objective: To investigate the effects of different periods application intra-aortic balloon pump( IABP) on in high-risk patients undergoing off-pump coronary artery bypass grafting( OPCAB).Method: Analysis of the timing and clinical effect of IABP therapy in 78 patients with high-risk coronary heart disease in the 586 cases of OPCAB in our center from January 2015 to August 2018. Divide patients into two groups,prophylactic group: 42 patients, preoperative IABP for high-risk patients;emergency group: 36 patients,IABP was placed during or after OPCAB,Compare IABP time,ICU time,postoperative hospital days,complications,and mortality between the two groups. Results: There was no difference in the incidence of complications between the two groups. The IABP time and ICU time of the prophylactic group were shorter than those of the emergency group. Prophylactic group mortality was significantly lower than emergency group. Conclusions: Evidence suggests that prophylactic use of IABP may shorten IABP and ICU time and reduce mortality in high risk patients,and prophylactic IABP is safe and effective for patients undergoing CABG. IABP re-implantation was the risk factor for short-term mortality.