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目的探讨不同类型急性心肌梗死(AMI)并心源性休克(CS)患者行主动脉内球囊反搏(IABP)治疗的有效性及预后影响。方法选择AMI并CS患者62例,其中男性38例,女性24例;年龄36~80岁,平均年龄66.5岁。分为2组,A组为非ST段抬高的心肌梗死(NSTEMI)并CS组,30例;B组为ST段抬高的心肌梗死(STEMI)并CS组,32例。2组患者均应用IABP,观察2组术后7 d、左心室射血分数(LVEF)、心脏指数(CI)、心肌肌钙蛋白T(c Tn T)及急性肾损伤(AKI)发生率变化及30 d病死率。结果 A组术后7 d LVEF及CI均较术前增加[38.60%±27.15%vs 35.73%±4.56%,(1.77±0.24)L/(min·m2)vs(1.59±1.28)L/(min·m2);P均<0.05],且A组CI明显高于B组,组间差异具有统计学意义[(1.77±0.24)L/(min·m2)vs(1.54±1.93)L/(min·m2);P<0.05]。两组AKI发生率较术前均无明显变化,差异无统计学意义(P>0.05)。A组术后7 d c Tn T明显低于B组[(1.48±1.42)μg/L vs(2.88±2.29)μg/L;P<0.05];两组术后AKI发生率及30 d病死率比较,差异有统计学意义(P>0.05)。结论对于不同类型AMI并CS患者,IABP的使用未改善30 d病死率或加重肾损伤,但可改善NSTEMI患者左心室收缩功能,提高其心输出量。
Objective To investigate the efficacy and prognosis of aortic balloon pump (IABP) in patients with different types of acute myocardial infarction (AMI) and cardiogenic shock (CS). Methods 62 patients with AMI and CS were selected, including 38 males and 24 females, aged from 36 to 80 years with a mean age of 66.5 years. The patients in group A were non-ST-segment elevation myocardial infarction (NSTEMI) and CS group, 30 patients in group A, and ST-segment elevation myocardial infarction (STEMI) in group B and 32 patients in CS group. The IABP was used in both groups, and the changes of LVEF, CI, cTn T and AKI were observed at 7 days after operation in both groups And 30 d mortality. Results The LVEF and CI of group A were significantly higher than those before operation (P <0.05) · M2); P <0.05], and the CI in group A was significantly higher than that in group B (P <0.05). There was significant difference between the two groups (1.77 ± 0.24 vs 1.54 ± 1.93) · M2); P <0.05]. There was no significant difference in AKI incidence between the two groups (P> 0.05). The Tn T at 7 days after operation in group A was significantly lower than that in group B [(1.48 ± 1.42) μg / L vs (2.88 ± 2.29) μg / L, P <0.05] , The difference was statistically significant (P> 0.05). Conclusions The use of IABP did not improve the 30-day mortality or aggravate renal injury in patients with different types of AMI and CS, but could improve left ventricular systolic function and increase cardiac output in patients with NSTEMI.