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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 further investigate the effects of intra-aortic balloon pump (IABP) on acute coronary syndrome (ACS) complicated with pump failure by assessing clinical efficacy, echocardiography, coronary angiography and brain natriuretic peptide (BNP) Effectiveness and safety. Subjects From January 2008 to May 2009 in our hospital 121 cases of ACS patients with pump failure, 76 males and 45 females, aged 40 to 78 years, mean (67 ± 11) years of age, including acute ST-elevation myocardial infarction (STEMI) in 77 cases, ST elevation myocardial infarction (NSTEMI) in 39 cases, unstable angina (UA) in 4 cases, Killip Ⅱ grade in 40 cases, Killip Ⅲ grade in 45 cases and Killip Ⅳ grade in 36 cases, in line with IABP indications, excluding Contraindications. Methods The patients were randomly divided into IABP group (61 cases) and control group (60 cases). Patients were treated with antiplatelet, anticoagulant, anti-angina pectoris, antiarrhythmic, antiarrhythmic (dopamine, dobutamine, Diuretics, vasodilators, etc.). All patients underwent coronary angiography and coronary intervention (PCI). Patients in IABP group were treated with IABP, but none in control group. Evaluation: ① clinical efficacy (angina pectoris and pump failure efficacy), the average length of stay and 30d mortality. ② coronary angiography to assess coronary recanalization. ③ echocardiography measured ejection fraction (EF value). ④ serum brain natriuretic peptide (BNP) changes. ⑤ IABP complications. Results Compared with the control group, there was no significant difference in the basic data, angina pectoris, pump failure and basic treatment between the two groups before and after treatment (P> 0.05). After the treatment, the effective rates of curative effect of angina pectoris and pump failure were 94.7 % vs81.6% (P <0.05), 85.8% vs61.2% (P <0.01), hospitalization day 8.6dvs11.7d (P <0.01) and30d mortality 1.6% (1/61) vs6.7% 4/60) (P <0.001). ② coronary angiography by coronary angiography to assess coronary recanalization rate of 90% (36/40) vs70.3% (26/37) (P <0.01). ③ Before and after treatment EF values were 35% → 58% vs 34% → 43% respectively. There was no significant difference before treatment (P> 0.05). The former was significantly higher than the latter after treatment (P <0.05). ④ The levels of BNP before and after treatment were 4893 ± 966 → 316 ± 91 vs 4687 ± 912 → 511 ± 120 (ng / L), respectively. There was no significant difference before and after treatment (P> 0.05). ⑤IABP complications: significant hemorrhage 3.2% (2/61), hematoma 3.2% (2/61), limb disorders 1.6% (1/61), related fever 1.6% (1/61), thrombocytopenia 4.8% 3/61), more than the control group, but the improvement of symptomatic treatment, no serious and irreversible complications. Conclusions IABP can improve hemodynamics, increase coronary blood supply, increase recanalization of coronary arteries and significantly improve angina pectoris and pump function in patients with ACS complicated with pump failure. The clinical effect is significant, without serious complications and high safety.