主动脉气囊反搏术在冠状动脉支架术围手术期心源性休克患者中的应用价值

Intraaortic balloon counterpulsation for patients with cardiogenic shock during periprocedural coronary stenting

目的 :小结主动脉气囊反搏术 (IABP)在冠状动脉支架术围手术期合并严重心源性休克患者中的应用结果。方法 :14例心肌梗死患者 (平均年龄 62 .3岁 )在冠状动脉支架术围手术期发生心源性休克而经股动脉行IABP。监测平均动脉压 (MBP)、心脏指数 (CI) ,同时在IABP前后测量肱动脉收缩压及舒张压力 ,并进行院内和出院后心功能以及股动脉并发症随访。结果 :8例在IABP支持下行直接或补救性冠状动脉支架术 ,3例在直接冠状动脉支架术后、3例在术中发生心源性休克而行IABP。 11例患者心功能得到迅速改善 ,在术后 8周内出院 ;3例患者术中死亡。门诊随访 6个月以上 ,3例心功能 (NYHA)Ⅱ级 ,6例心功能Ⅰ级。结论 :IABP通过增加冠状动脉舒张期灌注和降低左心室收缩期后负荷而使心源性休克患者受益 。

Objective:To present the following up result of intraaortic balloon counterpulsation (IABP)for patients with cardiogenic shock during periprocedural coronary stenting.Methods:Fourteen patients (with an average of 62.3 years old) with acute myocardial infarction (AMI) complicated cardiogenic shock during periprocedural coronary stenting underwent implantation of IABP via femoral artery. After implantation, mean blood pressure, cardiac index and brachial artery pressure were monitored and all patients were followed up for their cardiac function and local vascular complications for two months.Results:Under the support of IABP, a successful primary or rescue coronary stenting was performed in eight AMI patients complicated with cardiogenic shock .IABP was implanted because of occurrence of cardiogenic shock during (in three patients) or after (in other three) coronary interventions. Three patients died during the interventional procedure, and improvement of cardiac function was achieved in other nine patients, whom were discharged from the hospital in eight weeks. Six month follow up showed cardiac function NYHA Class Ⅱ in three patients and Class Ⅰ in six.Conclusion:The physiologic benefits of IABP counterpulsation in cardiogenic shock patients are ascribed to both an increase in diastolic coronary perfusion and decrease in systolic left ventricular afterload, which improve the safety of coronary stenting in these patients.