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目的 研究主动脉内气囊反搏(IABP)是否需要常规抗凝.方法 连续选择IABP病人153例,随机分组进入抗凝组(A组)71例,非抗凝组(B组)82例.抗凝组静脉给予肝素针维持aPTT于50～70s.非抗凝组无肝素针静脉维持.检测二组即刻,24h,48h以及IABP拔除后24h血小板计数,D 二聚体,纤溶酶原活化剂抑制物 1(PAI 1)和纤维蛋白降解产物(FDP)水平.观察IABP引起的肢体缺血或肢体出血等并发症、以及IABP表面的血栓情况.结果 抗凝组和非抗凝组的血小板计数和PAI 1水平于24h和48h均较本身的基础值显著下降(P<0.05).抗凝组和非抗凝组的D 二聚体和FDP水平于24h和48h均较本身的基础值显著升高(P<0.05).但二组间各个时段血小板计数,D 二聚体,PAI 1和FDP水平的比较均无显著性差异.抗凝组3例,非抗凝组2例发生一般肢体缺血.抗凝组2例大出血,8例一般出血;非抗凝组2例一般出血(P<0.05).IABP表面血栓二组均无发生.结论 IABP不需常规抗凝,抗凝不能预防IABP引起的肢体缺血.选择适当的导管经路和早期发现是预防并发症的关键.
Objective To study whether intra-aortic balloon pump (IABP) requires conventional anticoagulation.Methods 153 consecutive IABP patients were randomly divided into anticoagulation group (A group) and non-anticoagulation group (B group) Coagulation group intravenous heparin needle to maintain aPTT in 50 ~ 70s non-anticoagulant group heparin needle to maintain the detection of two groups immediately, 24h, 48h and IABP plucked 24 hours after platelet count, D dimer, plasminogen activator (PAI 1) and fibrin degradation products (FDP) were measured.IABP-induced complications such as limb ischemia or limb bleeding and thrombus on the surface of IABP were observed.Results The platelet counts of anticoagulant group and non-anticoagulant group (P <0.05), and the level of PAI-1 was significantly lower than the baseline values at 24 and 48 hours (P <0.05) .D-dimers and FDP levels in anticoagulation and non-anticoagulation groups were significantly higher than their baseline at 24 and 48 hours (P <0.05), but there was no significant difference in platelet count, D dimer, PAI 1 and FDP between the two groups at each time point.There were 3 cases in the anticoagulation group and 2 cases in the non-anticoagulation group Blood anticoagulation group 2 cases of hemorrhage, 8 cases of general bleeding; non-anticoagulant group 2 cases of general bleeding (P <0.05) .IABP surface thrombosis in both groups were no hair Conclusion IABP without conventional anticoagulant, anticoagulation can not prevent limb ischemia caused IABP. Select the appropriate conduit by the way is the key to prevention and early detection of complications.