王元,肖华,张金霞,黄军,向定成

• 1:南方医科大学
• 2:广州军区广州总医院心血管内科
• 3:赣州市人民医院心血管内科

摘要(Abstract)：

目的探讨急性心肌梗死(AMI)合并心源性休克(CS)或血流动力学紊乱患者应用主动脉内球囊反搏术(IABP)辅助治疗后,影响临床疗效的危险因素。方法回顾性分析广州军区广州总医院68例因AMI合并CS或血流动力学紊乱应用IABP辅助治疗的患者,根据其临床转归分为好转、死亡两组。对两组的性别、年龄、高血压、糖尿病、吸烟、高脂血症、既往冠心病史、入院时心率、入院时收缩压、入院时舒张压、病变血管支数、发病至行IABP术时间、TIMI血流、罪犯血管14项进行Logistic回归分析。结果本研究的死亡率为47.06%,所有危险因素中,罪犯血管是影响临床疗效的独立危险因素(P=0.015),其余危险因素均未影响预后(P>0.05)。罪犯血管组间比较显示,前降支与其他罪犯血管间差异有统计学意义(OR 0.047,95%CI 0.004~0.547,P=0.015)。结论罪犯血管是AMI合并CS或血流动力学紊乱应用IABP辅助治疗后影响临床疗效的危险因素。前降支病变患者应用IABP辅助治疗后可降低住院期间死亡率,左主干、右冠状动脉病变患者应用IABP辅助治疗后未能降低住院期间死亡率。

关键词(KeyWords)： 急性心肌梗死;心源性休克;血流动力学紊乱;主动脉内球囊反搏术

Abstract:

Keywords:

基金项目(Foundation): 广东省科技计划项目(2012B031800182)

作者(Author): 王元,肖华,张金霞,黄军,向定成

参考文献(References)：

• [1]Holmes DJ.Cardiogenic shock:a lethal complication of acute myocardial infarction.Rev Cardiovasc Med,2003,4:131-135.
• [2]Perera D,Stables R,Thomas M,et al.Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention:a randomized controlled trial.JAMA,2010,304:867-874.
• [3]崔丽丽,黄伟剑,李晟,等.急诊介入联合IABP治疗急性心肌梗死合并心源性休克.医学研究杂志,2013,5:163-166.
• [4]Ohman EM,Hochman JS.Aortic counterpulsation in acute myocardial infarction:physiologically important but does the patient benefit?Am Heart J,2001,141:889-892.
• [5]Rognoni A,Cavallino C,Lupi A,et al.Aortic counterpulsation in cardiogenic shock during acute myocardial infarction.Expert Rev Cardiovasc Ther,2014,12:913-917.
• [6]Hochman JS,Buller CE,Sleeper LA,et al.Cardiogenic shock complicating acute myocardial infarction--etiologies,management and outcome:a report from the SHOCK Trial Registry.Should we emergently revascularize occluded coronaries for cardiogenic shock?J Am Coll Cardiol,2000,36:1063-1070.
• [7]Sjauw KD,Engstrom AE,Vis MM,et al.Efficacy and timing of intra-aortic counterpulsation in patients with ST-elevation myocardial infarction complicated by cardiogenic shock.Neth Heart J,2012,20:402-409.
• [8]Thiele H,Zeymer U,Neumann FJ,et al.Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock(IABP-SHOCKⅡ):final 12 month results of a randomised,open-label trial.Lancet,2013,382:1638-1645.
• [9]Cheng JM,den Uil CA,Hoeks SE,et al.Percutaneous left ventricular assist devices vs.intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock:a metaanalysis of controlled trials.Eur Heart J,2009,30:2102-2108.
• [10]李南,韩静,冯斯婷,等.体外膜肺氧合对急性冠状动脉左主干病变的临床疗效分析.中国康复理论与实践,2013,19:589-591.
• [11]宋治远,李永华,姚青,等.兔右冠状动脉急性闭塞与再灌注时心律失常的发生与演变.中国心脏起搏与心电生理杂志,2003,17:51-54.
• [12]傅向阳,李公信,刘映峰,等.闭塞的右冠状动脉延迟再通对心律失常转归的影响.中国介入心脏病学杂志,1999,7:13-15.
• [13]Olasinska-Wisniewska A,Mularek-Kubzdela T,Grajek S,et al.Indications,results of therapy and factors which influence survival in patients treated with intra-aortic balloon counterpulsation.Kardiol Pol,2008,66:950-955,956-957.