主动脉内球囊反搏在急性心肌梗死合并心源性休克PCI术不同时机的应用效果

Application Effect of Intra-aortic Ballon Pump in Patients with Acute Myocardial Infarction Complicated with Cardiogenic Shock After PCI at Different Times

目的分析主动脉内球囊反搏(IABP)应用时机对急性心肌梗死(AMI)合并心源性休克(CS)经皮冠状动脉治疗(PCI)术患者血流动力学及心肌损伤标志物的影响。方法采用前瞻性研究方式,选取2017年7月至2022年1月于南阳南石医院行PCI治疗的60例AMI合并CS患者为研究对象,按随机数表法将其分为术前组(30例)、术后组(30例),两组均于入院后行常规PCI手术,术前组在PCI手术开始前置入IABP,术后组于PCI手术结束后1 h内置入IABP。比较两组患者手术前后临床指标(心脏指数、心率、尿量)、血流动力学指标[肺动脉楔压(PCWP)、有创平均动脉压(MABP)、有创动脉收缩压(SBP)]、心肌损伤标志物[肌酸激酶同工酶(CK-MB)、心脏型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)]、术后30 d病死率。结果治疗后,两组心率、尿量均有改善,且术前组心率低于术后组,尿量高于术后组(P<0.05)。治疗后,两组PCWP、MABP、SBP均有改善,且术前组PCWP低于术后组,MABP、SBP高于术后组(P<0.05)。治疗后,两组CK-MB、H-FABP、cTnI均有改善,且术前组低于术后组(P<0.05)。术前组共计5例患者在术后30 d死亡,病死率为16.67%(5/30),术后组6例患者死亡,病死率为20%(6/30),两组患者病死率比较,差异无统计学意义(P>0.05)。结论于PCI术前对AMI合并CS患者行IABP治疗可显著改善患者血流动力学以及心肌损伤,但未能提高患者近期生存率。

Objective To analyze the effect of the timing of intra-aortic balloon pump(IABP)on the hemodynamics and myocardial injury markers in patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)after percutaneous coronary intervention(PCI).Methods A total of 60 patients with AMI complicated with CS who underwent PCI in Nanyang Nanshi Hospital from July 2017 to January 2022 were selected as the research objects for prospective study.They were divided into preoperative group(30 cases)and postoperative group(30 cases)according to random number table method.Both groups underwent routine PCI after admission.The patients in the preoperative group were pre implanted with IABP at the beginning of PCI,and the patients in the postoperative group were implanted with IABP 1 hour after PCI.The clinical indexes(cardiac index,heart rate,urine volume),hemodynamic indexes[pulmonary artery wedge pressure(PCWP),invasive mean arterial blood pressure(MABP),invasive systolic blood pressure(SBP)],myocardial injury markers[creatine kinase MB(CK-MB),heart-type fatty acid binding protein(H-FABP),cardiac troponin I(cTnI)]and 30 days mortality were compared between the two groups.Results After treatment,the heart rate and urine volume of the two groups were improved,and the heart rate of the preoperative group was lower than that of the postoperative group,and the urine volume was higher than that of the postoperative group(P<0.05).After treatment,the PCWP,MABP and SBP of the two groups were improved,and the PCWP of the preoperative group was lower than that of the postoperative group,and the MABP and SBP of the preoperative group were higher than that of the postoperative group(P<0.05).After treatment,CK-MB,H-FABP and cTnI in the two groups were improved,and the preoperative group were lower than the postoperative group(P<0.05).A total of 5 patients in the preoperative group died 30 days after operation,and the mortality was 16.67%(5/30).A total of 6 patients in the postoperative group died,and the mortality was 20%(6/30).There was no statistical significant difference between the two groups(P>0.05).Conclusion IABP can significantly improve hemodynamics and myocardial injury in patients with AMI complicated with CS before PCI,but it can not improve the short-term survival rate.