主动脉内球囊反搏有效改善急性心肌梗死合并室间隔穿孔患者的循环

Intra-aortic balloon pump effectively improves the circulation in patients with acute myocardial infarction complicated with ventricular septal rupture

目的:探讨主动脉内球囊反搏(IABP)对急性心肌梗死(AMI)并发室间隔穿孔(VSR)患者循环的影响。方法:回顾性分析59例AMI合并VSR患者的临床资料,其中42例患者植入IABP辅助循环为IABP组,17例患者予以药物保守治疗为药物治疗组。比较IABP组与药物治疗组间患者一般血流动力学(包括IABP植入前、后平均血压、心率、无创心功能指标)、血乳酸水平、心脏超声等指标。根据患者是否存在休克状态,将59例患者分为休克组(40例)与非休克组(19例),比较休克组与非休克组间一般血流动力学(包括IABP植入前、后平均血压、心率、无创心功能)、血乳酸水平、心功能等指标,并观察30d临床预后。结果:IABP治疗组患者在植入24 h后平均心率下降、平均动脉血压升高、血乳酸水平下降、心脏超声左室射血分数(LVEF)值提升、无创心功能心脏指数升高(P均<0.05);药物治疗组上述指标无明显改变。IABP治疗组与药物治疗组30 d死亡率比较,差异无统计学意义(P>0.05)。结论:对于AMI合并VSR患者,植入IABP可显著改善患者血流动力学、酸中毒、临床心功能及循环状态。

Objective:To investigate the effect of intra-aortic balloon pump(IABP)on circulation support in the treatment of acute myocardial infarction(AMI)complicated with ventricular septal rupture(VSR).Methods:A retrospective analysis was performed on 59 patients with VSR,of which 42 patients were implanted with IABP auxiliary circulation,and 17 patients were treated with drugs.According to whether the patients had cardiogenic shock,59 patients were divided into cardiogenic shock group(n=40)and non-cardiogenic shock group(n=19).Changes in hemodynamics(including mean blood pressure,heart rate,non-invasive cardiac function before and after IABP implantation),lactic acid,and improvement of cardiac function between IABP and drug groups were compared.The 30-day clinical prognosis was compared.Results:In IABP treatment group,the average heart rate decreased,the average arterial blood pressure increased,the average lactic acid decreased,the LVEF value of cardiac ultrasound increased,and the noninvasive heart function index increased 24 after implantation(all P<0.05).There was no significant change in the drug treatment group.There was no significant difference between IABP treatment group and drug treatment group in 30-day mortality(P>0.05).Conclusion:For patients with AMI complicated with VSR,implantation of IABP can significantly improve hemodynamics,acidosis,clinical cardiac function.IABP effectively improves the circulation in patients with VSR.