主动脉内球囊反搏在急性心肌梗死后室间隔破裂中的应用价值

doi:10.3877/cma.j.issn.1674-6880.2018.06.006

目的

探讨主动脉内球囊反搏（IABP）在急性心肌梗死后室间隔破裂患者中的应用价值。

方法

选取上海同济大学附属东方医院心内科2008年1月至2016年12月共收治入院的急性心肌梗死合并室间隔破裂患者10例，分为IABP组和药物组，每组各5例。两组患者均给予多巴胺、硝酸甘油、呋塞米、阿司匹林、氯吡格雷等药物治疗，IABP组患者在药物治疗的基础上早期植入IABP。对两组患者的一般资料、既往病史、心肌梗死特点、心功能、循环以及尿量等进行比较。采用Kaplan-Meier曲线比较两组患者的生存情况。

结果

药物组患者胸痛时间[（153 ± 67）h vs.（34 ± 13）h]较IABP组显著延长（t = 1.591，P = 0.023）。治疗后，IABP组和药物组患者平均动脉压[（76 ± 7）mmHg vs.（66 ± 5）mmHg]及尿量[（42 ± 15）mL / h vs.（23 ± 8）mL / h]比较，差异均有统计学意义（t = 2.620、2.551，P = 0.031、0.034）。生存曲线结果显示，IABP组患者的生存情况显著优于药物组（χ² = 280.400，P = 0.041）。

结论

在急性心肌梗死后室间隔破裂患者早期使用IABP可以显著改善患者的血压以及尿量，稳定患者血流动力学，为手术争取时间，从而降低病死率，是手术前重要的过渡手段。

关键词: 主动脉内球囊反搏, 急性心肌梗死, 室间隔破裂

Objective

To evaluate the value of intra-aortic balloon pump (IABP) in patients with ventricular septal rupture after acute myocardial infarction.

Methods

From January 2008 to December 2016, 10 patients with acute myocardial infarction complicated with ventricular septal rupture admitted to the Department of Cardiology, East Hospital Affiliated to Tongji University were selected, which were divided into the IABP group and drug group with 5 cases in each group. Both groups were treated with dopamine, nitroglycerin, furosemide, aspirin, clopidogrel, while patients in the IABP group were implanted with IABP on the basis of drug therapy. The general data, past history, myocardial infarction characteristics, cardiac function, circulation and urine volume were compared between these two groups. Kaplan-Meier curves were used to compare the survival in these two groups.

Results

The time of chest pain in the drug group [(153 ± 67) h vs. (34 ± 13) h] was significantly longer than that in the IABP group (t = 1.591, P = 0.023). After treatment, the mean arterial pressure [(76 ± 7) mmHg vs. (66 ± 5) mmHg] and urine volume [(42 ± 15) mL / h vs. (23 ± 8) mL / h] in the IABP group and drug group were significantly different (t = 2.620, 2.551; P = 0.031, 0.034). The survival curve showed that the survival condition of IABP group was significantly better than that of drug group (χ² = 280.400, P = 0.041).

Conclusions

Early use of IABP in patients with ventricular septal rupture after acute myocardial infarction can significantly improve their blood pressure and urine volume, stabilize hemodynamics, gain time for operation and thus reduce mortality. It is an important transitional method before operation.

Key words: Intra-aortic balloon pump, Acute myocardial infarction, Ventricular septum rupture

表1 两组急性心肌梗死后室间隔破裂患者心肌梗死特点比较（ ± s）

组别	例数	胸痛时间(h)	TNT(mmol/ L)	室壁瘤[例(%)]	前壁心肌梗死[例(%)]	下壁心肌梗死[例(%)]	左前降支病变[例(%)]	左前降支狭窄程度(%)
IABP组	5	34 ± 13	5.0 ± 2.6	2(40.0)	5(100.0)	1(20.0)	4(80.0)	99.5 ± 0.5
药物组	5	153 ± 67	5.4 ± 1.1	1(20.0)	3(60.0)	2(40.0)	2(40.0)	99.8 ± 0.4
t/χ²值	?	1.591	0.113	4.240	1.000	1.000	1.195	1.464
P值	?	0.023	0.913	0.685	0.347	0.347	0.286	0.203

表1 两组急性心肌梗死后室间隔破裂患者心肌梗死特点比较（ ± s）

组别	例数	胸痛时间(h)	TNT(mmol/ L)	室壁瘤[例(%)]	前壁心肌梗死[例(%)]	下壁心肌梗死[例(%)]	左前降支病变[例(%)]	左前降支狭窄程度(%)
IABP组	5	34 ± 13	5.0 ± 2.6	2(40.0)	5(100.0)	1(20.0)	4(80.0)	99.5 ± 0.5
药物组	5	153 ± 67	5.4 ± 1.1	1(20.0)	3(60.0)	2(40.0)	2(40.0)	99.8 ± 0.4
t/χ²值	?	1.591	0.113	4.240	1.000	1.000	1.195	1.464
P值	?	0.023	0.913	0.685	0.347	0.347	0.286	0.203

图1 两组急性心肌梗死后室间隔破裂患者的生存曲线图

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Value of intra-aortic balloon pump in ventricular septal rupture after acute myocardial infarction

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Value of intra-aortic balloon pump in ventricular septal rupture after acute myocardial infarction