主动脉内球囊反搏联合体外膜肺氧合对心源性休克病人存活率及安全性的影响

Influences of Intra-aortic Balloon Pump Combined with Extracorporeal Membrane Oxygenation on Survival and Safety in Patients with Cardiogenic Shock

目的观察主动脉内球囊反搏(IABP)联合体外膜肺氧合(ECMO)对心源性休克病人存活率及安全性的影响。方法回顾分析2014年9月—2018年3月石家庄市第一医院收治的心源性休克病人72例,根据治疗方式分为辅助组(39例)和对照组(33例)。对照组采用常规药物及呼吸支持治疗,辅助组在对照组基础上加用IABP和ECMO辅助支持治疗。比较两组病人治疗前后收缩压、舒张压、中心静脉压(CVP)、心率、肺毛细血管楔压(PCWP)、左室射血分数(LVEF)、心脏指数(CI)、血浆脑钠肽(BNP)、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及尿量,记录两组病人预后及并发症情况。结果两组治疗后收缩压、舒张压较治疗前升高,CVP、心率、PCWP较治疗前下降,差异均有统计学意义(P<0.05),辅助组治疗后收缩压、舒张压较对照组升高,CVP、心率、PCWP较对照组下降,但差异均无统计学意义(P>0.05)。两组治疗后LVEF、CI、尿量较治疗前增加(P<0.05),BNP、APACHEⅡ评分较治疗前降低(P<0.05);辅助组疗后LVEF、CI、尿量较治对照组增加(P<0.05);BNP、APACHEⅡ评分较对照组降低(P<0.05)。辅助组存活率高于对照组(P<0.05),两组神经压迫、出血、感染、下肢缺血发生率及存活者住院时间比较差异均无统计学意义(P>0.05)。结论ECMO联合IABP辅助治疗可以改善心源性休克病人心功能,提高病人存活率,且安全性较好。

Objective To observe intra-aortic balloon pump(IABP)combined with extracorporeal membrane oxygenation(ECMO)on survival and safety in patients with cardiogenic shock.Methods The clinical data of 72 patients with cardiogenic shock from September 2014 to March 2018 were retrospectively analysed.The patients were divided into auxiliary group(n=39)and control group(n=33)according to the treatment method.The patients in control group were treated with conventional medicine and respiratory support,and the patients in auxiliary group were treated with IABP and ECMO on the basis of control group.Artery systolic blood pressure(SBP),artery diastolic blood pressure(DBP),central venous pressure(CVP),heart rate(HR),pulmonary capillary wedge pressure(PCWP),left ventricular ejection fraction(LVEF),cardiac index(CI),plasma brain natriuretic peptide(BNP)levels,acute physiology and chronic health evaluation systemⅡ(APACHEⅡ)score and urine output before and after treatment were compared between two groups.Results Compared with data before treatment,SBP,DBP increased and CVP,HR,PCWP decreased after treatment in two groups,the differences were statistically significant(P<0.05),the above indexes after treatment in auxiliary group was better than those in control group,but the differences were not statistically significant(P>0.05).After treatment,LVEF,CI,urine volume increased and BNP,APACHE-Ⅱscore decreased in the two groups(P<0.05),the data in auxiliary group were better than those in control group(P<0.05).The survival rate of auxiliary group was higher than that of the control group(P<0.05).There were no significant diffierences in nerve compression,hemorrhage,infection,lower limb ischemia,hospital stay of survival between two groups(P>0.05).Conclusion IABP combined with ECMO can improve the cardiac function and survival,and the security is good in patients with cardiogenic shock.