主动脉内球囊反搏辅助治疗对急性心肌梗死危重症患者预后的影响

Effect of adjuvant intra-aortic balloon counterpulsation on the prognosis of critically ill patients with acute myocardial infarction

目的探讨主动脉内球囊反搏(IABP)辅助治疗对急性心肌梗死(AMI)危重症患者预后的影响。方法回顾性分析2011年10月至2016年10月沈阳医学院附属第二医院心血管内科收治并确诊为AMI患者50例的临床资料,根据治疗方式不同将其分为观察组和对照组,每组25例。对照组患者采用经皮冠状动脉介入治疗(PPCI),观察组患者则在对照组的基础上采用IABP辅助治疗。观察两组患者治疗前后呼吸频率(RR)、血氧饱和度(SPO_2)、心率(HR)、收缩压(SBP)、舒张压(DBP)、左心室射血分数(LVEF)等指标的变化情况以及术后并发症发生率。结果治疗前,两组患者RR、SPO_2、HR比较,差异均无统计学意义(均P>0.05)。治疗后,观察组患者RR[(20.51±2.29)次/min比(25.61±3.04)次/min,P <0.05]、HR[(75.01±8.25)次/min比(90.21±9.41)次/min,P<0.05]显著低于对照组,SPO_2[(94.41±4.25)%比(90.51±7.36)%,P <0.05]显著高于对照组,差异有统计学意义。治疗前,两组患者SBP、DBP、LVEF比较,差异均无统计学意义(均P>0.05)。治疗后,观察组患者DBP[(72.37±6.13)mmHg比(56.21±6.26)mmHg,P <0.05](1mmHg=0.133kPa)、SBP[(116.37±10.62)mmHg比(97.41±9.43)mmHg,P <0.05]、LVEF[(48.25±11.04)%比(36.91±9.47)%,P <0.05]均显著高于对照组,差异有统计学意义。两组患者均未发生死亡。观察组患者发生血小板减少1例、穿刺部位渗血1例,对照组各发生3例、2例。观察组患者术后并发症发生率显著低于对照组[8.0%比20.0%,P <0.05],差异有统计学意义(χ~2=4.618,P <0.05)。结论对AMI患者采用IABP进行辅助治疗可明显改善患者的生命指征数值,提高射血分数以及降低患者的并发症发生率。

Objective To investigate the effect of adjuvant intra-aortic balloon counterpulsation（IABP）on the prognosis of critically ill patients with acute myocardial infarction（AMI）.Methods The clinical data of 50 patients with AMI admitted to the Second Affiliated Hospital of Shenyang Medical College from October 2011 to October 2016 were retrospectively analyzed.According to different treatment methods,they were divided into observation group and control group.Group of 25 cases.Patients in the control group were treated with percutaneous coronary intervention（PPCI）,and patients in the observation group were treated with IABP on the basis of the control group.Changes in respiratory rate（RR）,oxygen saturation（SPO2）,heart rate（HR）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,and left ventricular ejection fraction（LVEF）were observed before and after treatment.And the incidence of postoperative complications.Results Before treatment,there were no significant differences in RR,SPO2 and HR between the two groups（all P >0.05）.After treatment,the RR of the observation group（[20.51±2.29）times/min vs（25.61±3.04）times/min,P <0.05],HR[（75.01±8.25）times/min vs（90.21±9.41）times/min,P <0.05]was significantly lower than the control group,SPO2[（94.41±4.25）% vs（90.51±7.36）%,P <0.05]was significantly higher than the control group,the difference was statistically significant.Before treatment,there were no significant differences in SBP,DBP and LVEF between the two groups（all P >0.05）.After treatment,the DBP[（72.37±6.13）mmHg ratio（56.21±6.26）mmHg,P <0.05],SBP[（116.37±10.62）mmHg vs（97.41±9.43）mmHg,P <0.05],LVEF [in the observation group（48.25±11.04）% vs（36.91±9.47）%,P <0.05]were significantly higher than the control group,the difference was statistically significant.No deaths occurred in either group.In the observation group,1 patient had thrombocytopenia,1 patient had oozing at the puncture site,and 3 patients and 2 patients in the control group.The incidence of postoperative complications in the observation group was significantly lower than that in the control group（8.0% vs 20.0%,P <0.05）,and the difference was statistically significant（χ2=4.618,P <0.05）.Conclusion The use of IABP for adjuvant therapy in patients with AMI can significantly improve the patient’s vital signs,improve ejection fraction,and reduce the incidence of complications.