主动脉内球囊反搏术在高危冠心病患者介入治疗中的应用(1)
[摘要] 目的 评价主动脉内球囊反搏术(IABP)对行介入治疗的高危冠心病患者的有效性、患者并发症和住院病死率影响。方法 52例高危冠心病患者应用IABP作血流动力学支持,分为择期血运重建组(n=20)和急诊血运重建组(n=28,其中4例进行保守治疗),比较两组临床特征、治疗效果和住院期间不良心血管事件。结果 两组患者平均年龄、体重指数及合并高血压、糖尿病比例差异无统计学意义,急诊血运重建组合并心力衰竭、心源性休克比例显著高于择期血运重建组(P<0.01)。IABP平均时间为(82.2±18.0) h,总有效率为86.5%(45/52)。院内病死率为11.5%(6/52)。急诊血运重建组4例死于心源性休克,4例行保守治疗患者中2例死于多器官功能衰竭。18例心源性休克患者中4例(22.2%)死亡。结论 IABP与冠脉血管重建术联合治疗高危冠心病患者,可降低住院病死率,提高手术安全性。
[关键词] 主动脉内球囊反搏术;冠心病,高危;冠状动脉血管重建术
[中图分类号] R541.4[文献标识码] A[文章编号] 1671-7562(2009)06-0429-03Application of intraaortic balloon pump among highrisk patients undergoing percutaneous coronary intervention with coronary artery disease
MA Genshan,CHEN Zhong,FENG Yi,TANG Chengchun,SHEN Chengxing,LUO Dang,DAI Qiming,TONG Jiayi,DING Jiandong
(Department of Cardiology,Zhongda Hospital,Southeast University,Nanjing 210009,China)
Abstract:Objective To assess intraaortic balloon pump (IABP) on effectiveness,morbidity and death in hospital among highrisk patients undergoing coronary revascularization.Methods Fivtytwo patients with high risk coronary artery disease (CAD) inserted with IABP were divided into elective revascularization group (n=20),urgent revascularization group (n=28,4 of them were given conservative treatment).The clinical characteristics,therapy effectiveness and adverse cardiovascular events in hospital were compared between different groups.Results Patients in urgent revasculization group had higher ratio of heart failure and cardiac shock compared with patients in elective revasclarization group (P<0.01).Mean time usage of IABP was (82.2±18.0) h,with effective ratio of 86.5%(45/52) and mortality of 11.5%(6/52).Four patients died of cardiac shock in urgent revascularization group and 2 patients given conservative treatment died of multiple organ failure.Conclusion Coronary revasclarization combined with IABP support could decrease inhospital death risk in highrisk CAD patients and improve procedural safety during coronary intervention.
Key words: intraaortic balloon pump;coronary artery disease;highrisk;coronary revascularization
(Modern Medical Journal,2009,37:429-431)
主动脉内球囊反搏术(IABP)是最常用的机械辅助循环方法,已成为急性心肌梗死合并心源性休克和重度急性左心衰竭治疗的重要组成部分,IABP及早应用可降低高危患者的病死率[1-2]。通过主动脉内放置球囊驱使血液流向外周循环,减少主动脉舒张末期容量及左心室后负荷,减少心脏做功和心肌耗氧量,降低左心室收缩期的室壁张力,可增加心排血量10%～40%,在危重患者的冠状动脉介入术和心脏血管外科手术中应用IABP可有效降低手术风险[1-6]。我们对行介入治疗的高危冠心病患者中IABP应用情况及其应用的有效性、患者并发症和住院病死率进行分析。
1 对象与方法
1.1 研究对象
东南大学附属中大医院心内科2006年6月至2009年6月3年间高危冠心病患者52例,分为择期血运重建组(n=20)和急诊血运重建组(n=28,4例经IABP辅助循环支持后症状明显改善而未行介入治疗)。其中男48例,女4例,平均年龄(62.5±8.7)岁。接受血运重建的48例中合并高血压病41例,合并糖尿病20例;急性心肌梗死(AMI)29例,不稳定心绞痛19例,其中6例为陈旧性心肌梗死;并发严重心律失常12例(室速12例,室颤4例);心源性休克18例,心功能衰竭(Killip 3~4级)14例。所有患者冠脉造影、介入治疗及置入IABP前签署知情同意书。
1.2 冠脉介入术前准备
所有患者冠状动脉造影前和(或)介入治疗前常规服阿司匹林、氯吡格雷,伴Ⅲ度房室传导阻滞患者先行心脏临时起搏治疗。冠状动脉介入术后常规皮下注射低分子肝素。冠状动脉介入路径由手术者决定。
1.3 IABP适应证
(1)急性心肌梗死(AMI)合并心源性休克,药物治疗血压难以回升时,作为冠状动脉造影和急诊血运重建术前的一项稳定措施;(2)AMI或不稳定性心绞痛顽固性室性心动过速反复发作伴血流动力学不稳定;(3)AMI或顽固性心绞痛发作时作为冠状动脉造影和血运重建术前的一项治疗措施;(4)经造影证实为左主干病变和(或)多支冠脉严重病变,拟进行优势血管介入治疗。
1.4 IABP禁忌证
(1)合并重度主动脉瓣反流;(2)严重的周围血管疾病,如存在穿刺侧的股动脉和(或)髂动脉严重狭窄或钙化病变;(3)降主动脉或腹主动脉瘤;(4)严重肥胖致使无法完成股动脉穿刺;(5)血小板计数<80×1012 L-1,有出血倾向者;(6)有智力障碍者。, 百拇医药
[关键词] 主动脉内球囊反搏术;冠心病,高危;冠状动脉血管重建术
[中图分类号] R541.4[文献标识码] A[文章编号] 1671-7562(2009)06-0429-03Application of intraaortic balloon pump among highrisk patients undergoing percutaneous coronary intervention with coronary artery disease
MA Genshan,CHEN Zhong,FENG Yi,TANG Chengchun,SHEN Chengxing,LUO Dang,DAI Qiming,TONG Jiayi,DING Jiandong
(Department of Cardiology,Zhongda Hospital,Southeast University,Nanjing 210009,China)
Abstract:Objective To assess intraaortic balloon pump (IABP) on effectiveness,morbidity and death in hospital among highrisk patients undergoing coronary revascularization.Methods Fivtytwo patients with high risk coronary artery disease (CAD) inserted with IABP were divided into elective revascularization group (n=20),urgent revascularization group (n=28,4 of them were given conservative treatment).The clinical characteristics,therapy effectiveness and adverse cardiovascular events in hospital were compared between different groups.Results Patients in urgent revasculization group had higher ratio of heart failure and cardiac shock compared with patients in elective revasclarization group (P<0.01).Mean time usage of IABP was (82.2±18.0) h,with effective ratio of 86.5%(45/52) and mortality of 11.5%(6/52).Four patients died of cardiac shock in urgent revascularization group and 2 patients given conservative treatment died of multiple organ failure.Conclusion Coronary revasclarization combined with IABP support could decrease inhospital death risk in highrisk CAD patients and improve procedural safety during coronary intervention.
Key words: intraaortic balloon pump;coronary artery disease;highrisk;coronary revascularization
(Modern Medical Journal,2009,37:429-431)
主动脉内球囊反搏术(IABP)是最常用的机械辅助循环方法,已成为急性心肌梗死合并心源性休克和重度急性左心衰竭治疗的重要组成部分,IABP及早应用可降低高危患者的病死率[1-2]。通过主动脉内放置球囊驱使血液流向外周循环,减少主动脉舒张末期容量及左心室后负荷,减少心脏做功和心肌耗氧量,降低左心室收缩期的室壁张力,可增加心排血量10%～40%,在危重患者的冠状动脉介入术和心脏血管外科手术中应用IABP可有效降低手术风险[1-6]。我们对行介入治疗的高危冠心病患者中IABP应用情况及其应用的有效性、患者并发症和住院病死率进行分析。
1 对象与方法
1.1 研究对象
东南大学附属中大医院心内科2006年6月至2009年6月3年间高危冠心病患者52例,分为择期血运重建组(n=20)和急诊血运重建组(n=28,4例经IABP辅助循环支持后症状明显改善而未行介入治疗)。其中男48例,女4例,平均年龄(62.5±8.7)岁。接受血运重建的48例中合并高血压病41例,合并糖尿病20例;急性心肌梗死(AMI)29例,不稳定心绞痛19例,其中6例为陈旧性心肌梗死;并发严重心律失常12例(室速12例,室颤4例);心源性休克18例,心功能衰竭(Killip 3~4级)14例。所有患者冠脉造影、介入治疗及置入IABP前签署知情同意书。
1.2 冠脉介入术前准备
所有患者冠状动脉造影前和(或)介入治疗前常规服阿司匹林、氯吡格雷,伴Ⅲ度房室传导阻滞患者先行心脏临时起搏治疗。冠状动脉介入术后常规皮下注射低分子肝素。冠状动脉介入路径由手术者决定。
1.3 IABP适应证
(1)急性心肌梗死(AMI)合并心源性休克,药物治疗血压难以回升时,作为冠状动脉造影和急诊血运重建术前的一项稳定措施;(2)AMI或不稳定性心绞痛顽固性室性心动过速反复发作伴血流动力学不稳定;(3)AMI或顽固性心绞痛发作时作为冠状动脉造影和血运重建术前的一项治疗措施;(4)经造影证实为左主干病变和(或)多支冠脉严重病变,拟进行优势血管介入治疗。
1.4 IABP禁忌证
(1)合并重度主动脉瓣反流;(2)严重的周围血管疾病,如存在穿刺侧的股动脉和(或)髂动脉严重狭窄或钙化病变;(3)降主动脉或腹主动脉瘤;(4)严重肥胖致使无法完成股动脉穿刺;(5)血小板计数<80×1012 L-1,有出血倾向者;(6)有智力障碍者。, 百拇医药