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术前主动置入主动脉内球囊反搏在极高危冠状动脉旁路移植患者中的应用

A clinical study of preoperative prophylactic application of intra-aortic balloon pump in extreme high-risk patients undergoing coronary artery bypass grafting

摘要:

目的 对比术前预防性主动置入和被动紧急置入主动脉内球囊反搏(IABP)对极高危冠心病患者手术疗效的影响.方法 回顾性分析2008年1月至2011年6月接受冠状动脉旁路移植术(CABG)以及部分合并心肌梗死机械并发症行外科手术的患者资料,筛选出欧洲心脏手术风险评估系统评分≥12分的极高危患者,其中同时置入IABP 92例,男性71例,女性21例,年龄49~82岁,平均60.4岁.术前预防性主动置入IABP共57例(主动组),术中或术后因各种不利因素紧急被动置入IABP共35例(被动组).比较两组围手术期情况.结果 主动组围手术期病死率1.8%,低于被动组的11.4%(x2=3.949,P=0.047);心肌梗死率3.5%,低于被动组的17.1% (x2 =5.077,P=0.024).主动组呼吸机辅助时间、IABP使用时间、平均ICU住院时间(t=4.113 ~4.795),血管活性药物指数、急性肾损害(x2=5.077~23.521)低于被动组(P均<0.05).两组IABP重大并发症发生率差异无统计学意义(P=0.431).结论 对于极高危CABG患者,术前预防性主动置入较被动紧急置入IABP能降低CABG围手术期病死率、心肌梗死发生率,减少术后正性肌力药物的剂量,缩短IABP和呼吸机支持时间以及ICU住院时间,减少急性肾损害.

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abstracts:

Objective To compare the clinical outcome between the intra-aortic balloon pump (IABP) inserted in the preoperative prophylactic condition and in the emergent condition for the patients with extreme high risks undergoing coronary artery bypass grafting (CABG).Methods Totally 92 extreme high risk patients undergoing CABG combined with IABP supporting,whose European System for Cardiac Operative Risk Evaluation were equal or more than 12 points,some also undergoing surgical operations of myocardial infarction mechanical complications from January 2008 to June 2011,were analyzed retrospectively.According to the IABP established time,these patients were divided into two groups:preoperative group (57 cases) and passive group (35 cases).Items of comparison between two groups were the rate of mortality,myocardial infarction rate,severity of postoperative myocardial dysfunction and inotropic drug consumption quantity,IABP support time,respiratory support time,ICU stay time,renal function and IABP related complications.Results Perioperative mortality and myocardial infarction rate in preoperative group (1.8%,3.5%) were significant lower than those in passive group (11.4%,17.1%) (x2 =3.949,P =0.047 ; x2 =5.077,P =0.024).Compared to passive group,the IABP support time,respiratory support time,and ICU stay time (t =4.113-4.795) ; severity of postoperative myocardial dysfunction and inotropic drug consumption quantity,and renal dysfunction (x2 =5.077-23.521) were decreased significantly in preoperative group (all P < 0.05).There were no significant difference in IABP related complications (P =0.431).Conclusions For extreme high risk CABG patients,comparing to passive insertion of the IABP,preoperative prophylactic application of IABP shows the advantages in reducing perioperative mortality,myocardial infarction rate,inotropic drug consumption quantity,renal dysfunction,ICU stav time,respiratory support time and IABP support time.

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