主动脉内球囊反搏支持下急性心肌梗死经皮冠状动脉介入治疗的临床应用

目的：观察急性心肌梗死（AMI）合并心功能不全高危患者在主动脉球囊反搏（IABP）支持下行经皮冠状动脉介入治疗（PCI）对早期病死率及心功能的影响。方法选择第四军医大学西京医院2012年9月至2013年2月收治的20例AMI患者于发病3~12 h内在IABP支持下行急诊冠状动脉造影术，并行经皮冠状动脉腔内血管成形术及支架置入术。观察IABP置入前后的血压变化，并于1周内行心脏超声心功能检查。结果患者应用IABP 24 h后，平均心率由（120.0±15.8）次/分降至（84.3±5.7）次/分，1周内心功能射血分数由（36±5）％改善为（44±4）％，患者术后收缩压和舒张压均有明显改善，差异有统计学意义（P＜0.05）。1例因肺部感染、呼吸衰竭而放弃治疗自动出院；出院后1个月死亡率为5％（1/20）。结论 IABP作为辅助手段可在AMI患者PCI术前早期预防性短期应用，以减少并发症的发生，降低病死率，改善术后近期心功能。

Clinical application of intra-aortic balloon pump and percutaneous coronary intervention in patients with acute my ocar- dial infarction

Objective To observe the effect of percutaneous coronary intervention （PCI） with the support of intra-aortic balloon pump counterpulsation（IABP） on early mortality and cardiac function of high-risk patients with acute myocardial infarc-tion（AMI）. Methods Twenty AMI patients,who were enrolled in Xijing Hospital of the Fourth Military University from Septem-ber 2012 to February 2013,had coronary arteriography（CAG） with the support of IABP within 3-6 h after onset,the blood vessel was with percutaneous transluminal coronary angioplasty（PTCA） and stent implantation. To observe the changes of blood pressure before and after IABP support,and to inspect the cardiac function by echocardiography within 1 week. Results 24 h after IABP support,the average heart rate decreased from（120.0±15.8）beats/min to（84.3±5.7） beats/min;left ventricular ejection fraction （LVEF） was improved from （36±5）%to （44±4）%;the systolic blood pressure（SBP） and diastolic blood pressure（DBP） im proved obviously;the differences had statistical significance（P〈0.05）. 1 case left hospital because of pulmonary infection and res-piratory failure and died 1 month after discharge,with the death rate of 5%（1/20）. Conclusion Short-term application of IABP, as assistance,can reduce the incidence of complications,decrease death rate and improve the post-operative recent cardiac func-tion in the early prevention of AMI patients with PCI.