早期应用主动脉内气囊反搏术对择期PCI的大面积STEMI患者临床预后的影响

目的研究早期应用主动脉内气囊反搏术（IABP）对择期行经皮冠状动脉介入治疗（PCI）的大面积急性ST段抬高型心肌梗死（STEMI）患者临床预后的影响。方法STEMI患者100例，发病12-72h之内，随机分为两组：对照组给予规范的药物治疗，治疗组在规范药物治疗的基础上床旁应用IABP3-5d。两组均于10～14d后行冠脉造影及PCI术，评价梗死相关血管PCI术前及术后冠脉血流（TIMI）、术后4周心功能及主要不良心脏事件的发生情况。结果治疗组PCI术前TIMI血流0及1级者少于对照组，TIMI3级者多于对照组，PCI术后4周主要不良心脏事件的发生率低于对照组，左心室射血分数（LVEF）高于对照组，差异有统计学意义（P〈0．05）。结论对于择期行PCI的大面积STEMI患者早期应用IABP，能改善梗死相关血管的TIMI血流，减少术后4周主要不良心脏事件的发生率，改善心功能，临床应用安全有效。IABP应用宁早勿晚。

The effect of early application of IABP in patients with STEMI for elective PCI

Objective To evaluate the effect of early application of intra-aortic balloon pump counterpulsation（IABP） in patients with ST-segment elevation acute myocardial infarction （STEMI）for elective percutaneous coronary interventional （PCI）. Methods 100 STEMI patients were randomized into two groups： 52 patients in test group and 48 in control group. All the individuals onset of STEMI had been 12-72 hours, the patients in test group receiving IABP support treatment for 3 to 5 days and the patients in control group not. All the individuals were performed PCI after 10 to 14 days. Thrombolysis in acute myocardial infarction （TIMI） grade was studied before and after PCI. The major adverse cardiac events（MACE ） and heart function at 4 weeks were studied. Results In test group, TIMI 0-2 flow rate was significant lower than those in control group before PCI （7.7% and 22.9%, P=0.033）. TIMI 3 flow rate was significant higher than those in control group after PCI （92.3% and 75.0% ,P= 0.018）, the occurrence of MACE at 4 weeks was significant lower than those in control group （5.8% and 18.8%, P=0.0d6 ）. Left ventricle ejection fraction （LVEF） was significant higher than those in control group. Conclusion Early application of IABP in patients with STEMI for elective PCI is safe and effective, which may reduce the occasion of MACE, and improve LVEF. The application of IABP muse be early .