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目的:观察主动脉球囊反搏(IABP)辅助下急性心肌梗死(AMI)合并心源性休克患者行急诊经皮冠状动脉介入治疗(PCI)的疗效。方法:回顾性分析2000年1月至2007年12月住院的56例AMI并心源性休克患者在IABP辅助下行急诊PCI治疗及近期随访的临床资料。结果:冠状动脉造影示:单支血管病变8例,双支血管病变15例,三支血管病变25例,并左主干病变8例。56例患者梗死相关动脉全部再通,51例血流达到TIMI3级,5例患者发生慢血流或无复流。急诊介入术中死亡2例,介入治疗术后住院期内死亡17例。住院期间总死亡率为34%(19/56)。在随访至30d时行心脏彩超检查,左室射血分数均值为(0.37±0.11)。期间1例死于心衰;6例心绞痛复发;9例有心功能不全表现。无证实的亚急性血栓形成,无靶病变血管重建治疗或再次心肌梗死。结论:AMI并心源性休克的患者在IABP支持下行急诊PCI治疗,能改善心源性休克的血流动力学异常,有效地恢复梗死区心肌再灌注,降低死亡率。
Objective: To observe the effect of emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock assisted by aortic balloon pump countercurrent (IABP). Methods: The clinical data of 56 patients with AMI and cardiogenic shock who were hospitalized from January 2000 to December 2007 in IABP-assisted emergency PCI and recent follow-up were retrospectively analyzed. Results: Coronary angiography showed: 8 cases of single vessel disease, 15 cases of double vessel disease, 25 cases of 3 vessel disease and 8 cases of left main disease. Fifty-six patients had recanalization of the infarct-related arteries, 51 of them reached TIMI grade 3, and 5 had slow or no reflow. Two patients died during emergency intervention and 17 died during hospitalization after interventional therapy. The total mortality during hospitalization was 34% (19/56). During follow-up to 30 days underwent echocardiography, the mean left ventricular ejection fraction was (0.37 ± 0.11). During which 1 died of heart failure; 6 cases of recurrence of angina; 9 cases of cardiac insufficiency. Unproven subacute thrombosis, target-free revascularization or recurrent myocardial infarction. Conclusions: Patients with AMI and cardiogenic shock who underwent emergency PCI with IABP support could improve the hemodynamic abnormality of cardiogenic shock, effectively restore myocardial reperfusion in infarction area and reduce mortality.