摘要
目的通过评估临床疗效、心脏彩超、冠脉造影和脑利钠肽(BNP)的变化,进一步研究主动脉内球囊反搏(IABP)对急性冠脉综合征(ACS)合并泵功能衰竭治疗的有效性和安全性。对象2008年1月至2009年5月我院ACS合并泵功能衰竭患者121例,男76例,女45例,年龄40～78岁,平均(67±11)岁,其中急性ST抬高心肌梗死(STEMI)77例、ST不抬高心肌梗死(NSTEMI)39例、不稳定性心绞痛(UA)4例,KillipⅡ级40例、KillipⅢ级45例、KillipⅣ级36例,符合IABP治疗适应证、排除禁忌证。方法随机分成IABP组(61例)和对照组(60例),基本药物治疗根据病情使用抗血小板、抗凝、抗心绞痛、抗心律失常、抗心衰(多巴胺、多巴酚丁胺、洋地黄、利尿剂、血管扩张剂等),所有患者均同意行冠脉造影和冠脉介入治疗(PCI),IABP组使用IABP治疗,对照组则无。评估:①临床疗效(心绞痛疗效和泵衰竭疗效)、平均住院日和30d病死率。②冠脉造影检查评估冠脉再通。③心脏彩超测定射血分数(EF值)。④血清脑利钠肽(BNP)变化。⑤IABP并发症。结果 IABP组和对照组比较,两组在治疗前基本资料、心绞痛、泵衰竭和基本治疗均无显著差异(P>0.05),治疗后:①心绞痛疗效有效率和泵衰竭疗效有效率分别为94.7%vs81.6%(P<0.05)和85.8%vs61.2%(P<0.01)、住院日8.6dvs11.7d(P<0.01)、30d病死率1.6%(1/61)vs6.7%(4/60)(P<0.001)。②STEMI冠脉造影检查评估冠脉再通率90%(36/40)vs70.3%(26/37)(P<0.01)。③治疗前后EF值分别为35%→58%vs34%→43%,治疗前无显著差异(P>0.05),治疗后前者比后者有明显提高(P<0.05)。④BNP治疗前后分别为4893±966→316±91vs4687±912→511±120(ng/L),治疗前无显著差异(P>0.05),治疗后前者比后者有显著降低(P<0.01);⑤IABP并发症:明显出血3.2%(2/61)、血肿3.2%(2/61)、肢体血运障碍1.6%(1/61)、相关发热1.6%(1/61)、血小板减少4.8%(3/61),比对照组较多,但经对症处理好转、无严重和不可逆并发症。结论 IABP对ACS合并泵衰竭能够改善血流动力学、增加冠脉血供和增加冠脉再通,明显改善心绞痛和泵功能,临床疗效显著,无严重并发症,安全性较高。
Objective To evaluate the therapeutic effect and safty,and the result of coronary angiography（CAG） and serum brain natriuretic peptide（BNP） level in patients with acute coronary syndrome complicated with pump failure treated with intra aortic balloon pump（IABP）.Methods Between January 2008 and May 2009,121 patients with acute coronary syndrome（ACS） and pump failure were divided into IABP group（61 cases） and the control group（60 cases）,respectively.there were 76 mail patiens and 45 femail patiens,while 77 were ST-elevation myocardial infarction（STEMI）,35 were Non ST-elevation myocardial infarction（NSTEMI） and 9 were Unstable angina pectoris（UA）.40 patiens fell into Killip rank-Ⅱ,45 patiens fell into iKillip rank-Ⅲ,while 36 pitiens fell into Killip rank-Ⅳ.All of them were suitable for IABP treatment and there was no contraindication.They all received basical treatment,including anti-anginal therapy,anti-pletlet,cholesterol lowing,eatl.All patiens underwent CAG and percutaneous coronary intervention（PCI）.The IABP group were treated with IABP while the control group were not.Evaluations：① Clinical effect（including the effect of angina and pump failure）,timing in hospital,death rate in 30 d.② the CAG result after PCI.③ the level of EF measured by cadioultrasound.④ The level of BNP were mesured.Results After treatment,the IABP group were higher significantly than the control group in clinical effect,including the effect of angina and pump failure[94.7% vs 81.6%（P0.01）和85.8% vs 61.2%（P0.01）].In timing hospital,the result was 10.6 d vs 15.7 d（P0.01）,and the IABP group was higher than the control group in successful rate of PCI[75%（30/40） vs 54.1 %（20/37）（P0.01）] and lower than the control group in death rate 1.6%（1/61） vs 6.7%（4/60）（P0.001）,and the level of EF（35%→58% vs 34%→43%） made no difference before treatment,while made remarkable difference after treatment（P0.05）.On the other hand,there were no difference between two groups on BNP before treatment（[WTBX]P[WTBZ]0.05）;IABP group was lower than the control group on the BNP after treatment,there were significantly difference in two groups[4893±966→316±91 vs 4687±912→511±120（ng/L）]（[WTBX]P[WTBZ]0.01）.As for the complication,there were few patients with bleeding [3.2%（2/61）],hematoma[3.2%（2/61）],acute earterial embolism[1.6%（1/61）],fever[1.6%（1/61）],pletlet decreasing [4.8%（3/61）].Although there were more complications in IABP group,after treatment the symptom got advanced and there were no severe complication.[WT9.HZ]Conclusion[WT9.BZ] IABP can significantly advance the hemodynamic indexes and serum BNP level of the patients of ACS with pump failure,can ease the pain of Angina,improve the tolerance and successful rate of the PCI treatment,and decrease death rate.and there is no severe complication,and it is a kind of safe treatment.[JP3][WT9.HZ]
出处
《中国实用医药》
2011年第35期6-9,共4页
China Practical Medicine
基金
2009年广东省科技计划项目(项目编号:2009B030801338)
关键词
急性冠脉综合征
泵衰竭
主动脉内球囊反搏
脑利钠肽
[WT9.BZ] Acute coronary syndrome
Pump failure
Intra aortic balloon pump
Brain natriuretic peptide
作者简介
通讯作者：吴铿E—mail：zjwukeng@hotmail．com.
