高危复杂冠脉病变经皮冠状动脉介入术前保护性置入主动脉内球囊反搏的临床观察
Clinical observation of protective intra-aortic balloon pump before percutaneous coronary intervention in high risk coronary lesions

孔祥勇.高危复杂冠脉病变经皮冠状动脉介入术前保护性置入主动脉内球囊反搏的临床观察[J].内科急危重症杂志,2019,25(6):450-453

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DOI：10.11768/nkjwzzzz20190604

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基金项目:国家自然科学基金面上项目（No:81870192）

作者	单位	E-mail
孔祥勇	中国科学技术大学附属第一医院安徽省立医院	lkma119@163.co

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中文摘要:

目的：探讨高危复杂冠脉病变患者经皮冠状动脉介入术（PCI）前保护性置入主动脉内球囊反搏(IABP) 对围手术期临床疗效的影响。方法：回顾性分析高危复杂冠脉病变的患者190例，其中PCI术前保护性置入IABP的79例为观察组，其余111例没有预先置入 IABP或术中病情变化紧急被动置入IABP的患者为对照组。比较2组术中、术后及临床转归情况。结果：观察组中仅1例患者术后IABP持续携带3d拔除，其余均术后即刻拔除；观察组患者均能耐受手术，术后无急性、亚急性血栓，无心力衰竭发生，无1例死亡。观察组入路并发症的发生率以及血红蛋白下降水平明显高于对照组（均P<0.05）。对照组有3例术中突发急性左心衰，1例发生冠脉严重无复流，从而被动置入IABP，此3例患者中1例因心原性休克抢救无效死亡，2例IABP持续携带5d后拔除。结论：高危复杂冠脉病变介入治疗中，保护性预置入IABP能明显提高患者的手术耐受性和手术成功率，减少PCI术中并发症，降低围手术期不良事件。

英文摘要:

Objective: To investigate the effect of intra-aortic balloon pump (IABP) placed protectively before percutaneous coronary intervention (PCI) in patients with high-risk coronary artery disease. Methods: 190 patients with high-risk coronary lesions were retrospectively analyzed, including 79 patients given protective IABP before PCI as observation group, and the remaining 111 patients as control group without placing IABP or passive IABP implantation under the intra-operative emergency conditions. The intra-operation and postoperative outcomes were compared between two groups. Results: In the observation group, IABP was removed immediately after surgery. The patients in the observation group could tolerate the surgery. The incidence of entry complications and the decrease of hemoglobin were significantly higher than in the control group (all P<0.05). In the control group, there were 3 patients suffering from passive IABP implantation because of acute left heart failure during surgery. IABP was passively implanted in 1 patient due to severe coronary artery non-reflow. Among the 3 patients, 1 died due to cardiogenic shock, and IABP was removed after 5 days in 2 patients. Conclusion: In the interventional treatment of high-risk coronary lesions, the protective prepositioning of IABP can significantly improve the patient's surgical tolerance, reduce intra-operative complications and perioperative major adverse cardiac events.