IABP辅助PCI治疗高危急性冠脉综合征的效果评估

目的：评价主动脉内球囊反搏术( IABP)辅助经皮冠状动脉介入( PCI)治疗高危急性冠脉综合征( ACS)患者的效果。方法选取95例ACS合并血流动力学不稳定或心源性休克的高危患者并分为两组,50例患者PCI前24 h内进行IABP治疗(IABP+PCI组),45例直接PCI(PCI组)。在入院及PCI术后第5天分别检测N末端B型利钠肽原(NT-proBNP)和超敏C反应蛋白( hs-CRP)水平；入院时及出院后4周心脏彩超测定左心室射血分数( LVEF)。结果治疗前两组收缩压均偏低,两组差异无统计学意义(P>0．05)。治疗后,IABP+PCI组血压较PCI组血压明显升高(P<0．05)；同时IABP+PCI组病死率有所下降(P<0．05),住院天数减少(P<0．05)。两组治疗前的血浆NT-proBNP和hs-CRP差异无统计学意义(P>0．05),治疗后IABP+PCI组血浆NT-proBNP 和 hs-CRP水平较PCI组明显下降(P<0．05),LVEF明显提高(P<0．05)。结论 IABP辅助PCI治疗高危ACS患者,在一定程度上改善了血流动力学,并使住院天数和短期病死率有所下降,同时降低了血浆NT-proBNP 和 hs-CRP水平,提高了LVEF。

Efficacy evaluation of adjunctive IABP for high-risk ACS patients undergoing PCI

Objective To evaluate the efficacy of intra-aortic balloon pump( IABP) as an adjunct to percutaneous coronary interven-tion( PCI) for high-risk acute coronary syndromes( ACS) patients. Methods Ninety five high-risk ACS patients with unstable hemodynamic or cardiogenic shock who underwent PCI were divided into two groups, 50 patients were treated with IABP within 24 hours before PCI ( IABP+PCI group) , and 45 patients with PCI only ( PCI group) . Plasma NT-proBNP and hs-CRP were measured on the first day during hospitali-zation and fifth day after PCI. Left ventricular ejection fraction( LVEF) was measured by echocardiography on the first day during hospitaliza-tion, and 4 weeks after discharge. Results SBP of the two groups was low before the treatment, with no significant difference between the two groups(P>0. 05). After the treatment, SBP was significantly higher in the patients underwent PCI with IABP support compared with control group(P<0. 05). Moreover, undergoing PCI with IABP support could decrease the short-time mortality(P<0. 05), and decrease the hospitalization days (P<0. 05). NT-proBNP and hs-CRP of the two groups were increased at the beginning of the treatment, but there was no significant difference between the two groups (P>0. 05). After the treatment, NT-proBNP and Hs-CRP decreased and LVEF increased more significantly in IABP group (P<0. 05). Conclusion For high-risk patients with unstable hemodynamics or cardiogenic shock, PCI with IABP support could improve hemodynamics to a certain extent and decrease hospitalization days and the short-time mortality;PCI with IABP support could also decrease plasma NT-proBNP, hs-CRP, and LVEF.