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目的探讨急性心肌梗死(acute myocardial infarction,AMI)危重症患者应用主动脉内球囊反搏(intra-aortic balloon pump,IABP)辅助治疗的预后。方法回顾性分析75例行IABP治疗的AMI患者的临床资料,着重分析患者合并症,IABP术的方法、结果及预后情况。结果IABP治疗时间为1d～39d,中位数为5d,存活组39例,死亡组36组,存活组心房颤动和肺部感染患者的比例低于死亡组,差异有统计学意义(P<0.05),其他合并症两组比较差异无统计学意义。存活组左心室射血分数IABP辅助治疗后高于死亡组治疗后,差异有统计学意义(48.6%±17.7%比39.1%±11.0%,P<0.05)。存活组行冠状动脉血运重建治疗率92.3%(36/39)高于死亡组的58.3%(21/36),差异有统计学意义(P<0.05)。根据IABP治疗时间,55例在IABP治疗≥2.5d组,20例在IABP治疗<2.5d组,2例感染均在IABP治疗≥2.5d组,1例发生与IABP相关金黄色葡萄球菌感染,存活;另1例是IABP穿刺部位感染,死亡。结论对AMI合并心源性猝死、心力衰竭、心肌缺血的患者,IABP治疗是一种有效的临时心室援助机械支持,能为患者行冠状动脉血运重建术和其他心脏手术赢得时间和机会。
Objective To investigate the prognosis of acute myocardial infarction (AMI) in critically ill patients undergoing intra-aortic balloon pump (IABP) adjuvant therapy. Methods The clinical data of 75 patients with AMI treated with IABP were retrospectively analyzed. The patients with complications, the IABP method, the outcome and the prognosis were analyzed. Results The duration of IABP treatment was 1d to 39d with a median of 5 days. There were 39 survivors and 36 deaths. The proportion of patients with atrial fibrillation and pulmonary infection in survival group was lower than that in death group (P <0.05) ), Other complications were no significant difference between the two groups. Survival group left ventricular ejection fraction IABP adjuvant therapy was higher than the death group after treatment, the difference was statistically significant (48.6% ± 17.7% vs 39.1% ± 11.0%, P <0.05). Survival group coronary artery revascularization rate of 92.3% (36/39) was higher than 58.3% (21/36) of death group, the difference was statistically significant (P <0.05). According to IABP treatment time, 55 cases were treated with IABP for 2.5 days or more, 20 cases were treated with IABP for 2.5 days or less, and 2 cases were treated with IABP for 2.5 days or more. One case had IABP-associated S. aureus infection and survived ; The other one was infected with IABP puncture site and died. Conclusion IABP is an effective temporary ventricular assist for patients with AMI complicated by sudden cardiac death, heart failure and myocardial ischemia, which can gain time and opportunity for coronary revascularization and other cardiac surgery.