主动脉内球囊反搏在急性心肌梗死合并泵衰竭急诊介入中的辅助治疗

Pump failure complicating acute myocardial infarction: the use of the intraaortic balloon pump support in emergency interventional procedures

目的 评价在急性心肌梗死 (AMI)合并泵衰竭急诊介入中辅以主动脉内球囊反搏(IABP)治疗的安全性及有效性。方法 对 87例合并严重泵衰竭甚或心源性休克的AMI患者行急诊介入治疗。将 2 1例 (2 4% )同时接受IABP辅助治疗的患者设为IABP组 (A组 ) ,另 6 6例 (76 % )设为对照组 (B组 )。比较两组临床特征、冠状动脉造影情况及住院期的临床疗效。结果 年龄、性别、发病初始至导管室时间、心肌梗死部位、冠状动脉病变支数、具体梗死相关动脉 (IRA)及血管重建术前梗死相关动脉血流TIMI分级等指标 ,A、B两组之间无统计学差异。心功能分级 (Killip分级 ) ,A组较B组严重 ;而住院期间 ,A组死亡率及血管再闭塞事件较B组明显降低。结论 对于高危AMI合并泵衰竭 ,尤其心源性休克的患者 ,在行急诊介入时 ,IABP的辅助使用明显降低住院期死亡率 ,减少血管再闭塞率 ,提高手术成功率 ,其远期预后有待进一步随访。

Objective To evaluate the effects of intraaortic balloon pump (IABP) support in the emergency interventional procedures on pump failure or cardiogenic shock complicating acute myocardial infarction (AMI). Methods Group A included 21 patients with IABP support during the emergent interventional procedures, and group B included 66 patients without IABP. The two groups were compared for clinical criteria and in-hospital events or complications.Results No significant differences were noted between the two groups witch regard to baseline age, gender, onset of chest pain, timing of intervention, location of AMI, the number of coronary artery diseases, individual infarct-related artery, and TIMI grade before intervention. The degree of pump failure was significantly worse in group A than in group B. In a follow-up period of in-hospital, mortality and revascularization in-hospital were lower in the patients with IABP than in the patients without IABP. Conclusion The combination of early IABP and successful emergency coronary intervention is associated with improved survival in patients with pump failure or cardiogenic shock complicating AMI.