IABP应用时机对高危PCI患者血流动力学及近期预后的影响

Influence of timing of IABP implantation on hemodynamics and short-term prognosis in patients with high-risk PCI

目的 探讨主动脉内球囊反搏(intra-aortic balloon pump, IABP)应用时机对高危经皮冠状动脉介入(percutaneous coronary intervention, PCI)患者血流动力学及近期预后的影响。方法 回顾性分析2018年3月至2022年5月在廊坊市第四人民医院行IABP辅助的96例高危PCI患者的临床资料。根据IABP应用时机分为术前组(PCI前置入,n=56)和术后组(PCI后置入,n=40)。收集两组患者年龄、性别、合并疾病、冠心病类型、冠状动脉病变部位、左心室射血分数(left ventricular ejection fraction, LVEF)及心源性休克(cardiogenic shock, CS)、急性心肌梗死(acute myocardial infarction, AMI)合并机械并发症、室性心律失常(ventricular arrhythmia, VA)等术前临床资料。比较两组患者手术前后平均动脉压(mean arterial pressure, MAP)、心率(heart rate, HR)及尿量。记录两组患者支架置入数、无复流现象(TIMI血流分级≤2级)率、IABP运转时间、IABP并发症、再次PCI率、院内病死率、术后30 d病死率等。分析患者术后30 d死亡的危险因素。结果 (1)术前组糖尿病、高血脂比例、左前降支和左主干病变、ST段抬高型心肌梗死(ST segment levation myocardial infarction, STEMI)、CS比例高于术后组(P<0.05),难治性心绞痛比例低于术后组(P<0.05)。(2)两组术前MAP、HR、尿量比较差异无统计学意义(P>0.05),术后1 d MAP、HR、尿量均有明显改善,但术前组改善程度大于术后组(P<0.05)。(3)术前组IABP运转时间、再次PCI率、院内及术后30 d病死率低于术后组(P<0.05)。(4)Logistic多因素回归分析显示PCI后应用IABP是近期预后的独立危险因素(P=0.001)。结论 对于高危PCI患者,接受术前IABP置入相比术后IABP置入有更好的近期预后。

Objective To explore the influences of timing of intra-aortic balloon pump(IABP) implantation on hemodynamics and short-term prognosis in patients with high-risk percutaneous coronary intervention(HR-PCI). Methods The clinical data of 96 high-risk PCI patients received IABP in Fourth People’s Hospital of Langfang City from March 2018 to May 2022 were retrospectively analyzed. According to the timing of IABP implantation, all patients were divided into a preoperative group(IABP implantation before PCI, n=56) and a postoperative group(IABP implantation after PCI, n=40). Preoperative clinical data such as age, sex, combined disease, type of coronary heart disease, position of coronary artery disease, left ventricular ejection fraction(LVEF), and cardiogenic shock(CS), acute myocardial infarction(AMI) combined with mechanical complications, and ventricular arrhythmia(VA) were collected in the 2 groups.The mean arterial pressure(MAP), heart rate(HR), and urine volume before and after the operation were compared between the 2 groups. The stenting number, no blood flow rate(TIMI blood flow classification≤grade 2), IABP running time, IABP complications, recurrent PCI, nosocomial mortality, and 30 d postoperative mortality were recorded in the 2 groups. Risk factors of death≤30 d after operation were analyzed. Results(1)The proportion of diabetes, hyperlipidemia, left anterior descending branch and left main disease, STEMI, and CS in the preoperative group was higher than that in the postoperative group(P<0.05), and the proportion of refractory angina pectoris was lower than that in the postoperative group(P<0.05).(2)There were no statistically significant differences in MAP, HR, and urine volume before the operation between the 2 groups(P>0.05), while MAP, HR, and urine volume were significantly improved at the 1 d after the operation, but the improvement degree of the preoperative group was higher than that of the postoperative group(P<0.05).(3)IABP running time, rate of re-PCI, hospital mortality and 30 d postoperative mortality in the preoperative group were lower than those in the postoperative group(P<0.05).(4)Multivariate logistic regression analysis showed that IABP after PCI was an independent risk factor for short-term prognosis(P=0.001). Conclusion Compared with IABP implantation after PCI, IABP implantation before PCI can effectively improve the short-term prognosis of HR-PCI patients.