The Study on Application Timing of Intra-aortic Balloon Pump in ST-egment- elevation Myocardial Infarction Patients Complicated with Ventricular Septal Rupture
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摘要:
目的 研究主动脉内球囊反搏（intra-aortic balloon pump，IABP）在抢救ST段抬高型心肌梗死（ST-egment-elevation myocardial infarction，STEMI）合并室间隔穿孔（ventricular septum rupture，VSR）患者时的应用时机。 方法 回顾分析2019年1月至 2023年6月在昆明医科大学附属延安医院心内科住院治疗的 35 例 STEMI合并VSR患者的临床资料，其中20例置入IABP患者为药物联合IABP组，15例仅接受药物治疗患者为单纯药物治疗组。统计所有患者的血流动力学变化情况、泵功能改善情况、接受心脏外科手术前的院内死亡率和临床特点。 结果 2组患者的性别比例、年龄和室间隔穿孔直径等临床基线资料均无明显统计学差异（P > 0.05）。药物联合IABP组患者置入72 h后平均心率下降，平均动脉血压升高，中心静脉压力降低，左心室射血分数、胸腔积液及肺部B线减少，B型利钠肽（B-type natriuretic peptide， BNP）、血肌酐、血乳酸水平下降 （P < 0.05）；单纯药物治疗组上述指标呈恶化的趋势。药物联合IABP组患者30 d死亡率明显低于单纯药物治疗组患者（P < 0.05）；在药物联合IABP组中，早期置入IABP的患者死亡率明显低于超过72 h后置入的患者。 结论 STEMI患者合并VSR时，尽早使用IABP可显著改善STEMI合并VSR患者的泵功能和血流动力学并且降低接受心脏外科手术前的院内死亡率；长时间应用IABP引起相关并发症无增加的趋势。 -
关键词:
- ST段抬高型心肌梗死 /
- 室间隔穿孔 /
- 主动脉内球囊反搏 /
- 应用时机 /
- 预后
Abstract:Objective To study the effect of intra-aortic balloon pump （IABP） in the therapy of ST-segment-elevation myocardial infarction （STEMI） patients complicated with ventricular septal rupture （VSR）. Methods A retrospective analysis was performed on 35 STEMI patients complicated with VSR. Those patients were admitted in Yan’ an Hospital Affiliated to Kunming Medical University from January 2019 to June 2023.Patients were divided into the combine-treated group （20 cases） and the drug-treated group （15 cases） according to the therapeutic strategies. The combine-treated group received IABP implantation and drug therapy, and the drug-treated group only received drug therapy. The clinical characteristics, hemodynamic and cardiac function improvement and mortality were evaluated. Hemodynamic and cardiac function improvement were compared between the two groups. Results There were no statistically significant differences in age, male proportion and size of VSR between the two groups （P > 0. 05） . In the combine-treated group, the average heart rate, the average arterial blood pressure, central venous pressure, the LVEF value of cardiac ultrasound, pleural effusion, B-Line of lung, the level of B-type natriuretic peptide （BNP）, the level of serum creatinine and the level of serum lactic acid were improved at 72 h after IABP use （all P < 0. 05）. All these indicators got worse in the drug-treated group. The mortality rate of the combine-treated group was markedly lower than that of the drug-treated group （P < 0.05）. The mortality rate of patients who received IABP implantation within 72 h after VSR was lower than that of patients who received IABP implantation beyond 72 h after VSR. Conclusion For patients with AMI complicated with VSR, implantation of IABP can significantly improve hemodynamics, cardiac function and reduce mortality. -
表 1 2组患者的临床资料［（$ \bar x \pm s $）/ n（%）］
Table 1. Comparison of clinical data between two groups［（$ \bar x \pm s $）/ n（%）］
组别 n 性别 年龄（岁） 高血压 糖尿病 室间隔穿孔直径（mm） 男 女 药物联合IABP组 20 8（40.0） 12（60.0） 68.8 ± 4.6 11（55.0） 8（40.0） 10.4 ± 5.3 单纯药物治疗组 15 7（46.7） 8（53.3） 65.4 ± 7.0 8（53.3） 7（46.7） 9.8 ± 4.9 χ2/t − 0.157 0.701 0.259 0.203 0.845 P − 0.671 0.490 0.611 0.650 0.392 
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表 2 2组患者泵功能变化情况的比较［（$\bar x \pm s $）/ n（%）］
Table 2. Comparison of cardiac function between the two groups ［（$\bar x \pm s $）/ n（%）］
指标 时间 药物联合IABP组（n = 20） 单纯药物治疗组（n = 15） χ2/t P LVEF （$ \bar x \pm s$，%） 治疗前 34.6 ± 5.31 35.1 ± 3.34 1.33 0.18 治疗后 39.6 ± 6.10*# 31.6 ± 4.81 2.51 0.01*# BNP（pg/ml） 治疗前 4874.6 ± 325.344674.6 ± 416.51.26 0.21 治疗后 2684.6 ± 247.79*#5174.6 ± 525.63.94 <0.001*# 胸腔积液例（%） 治疗前 16（80） 11（73.33） 14.70 0.31 治疗后 7（35）*# 15（100） 29.51 0.012*# 肺部B线平均数（条） 治疗前 10.46 ± 2.10 11.6 ± 2.91 1.30 0.17 治疗后 4.5 ± 1.14*# 15.03 ± 2.81 3.01 0.002*# 注：与单纯药物治疗组治疗后比较， * P < 0.05；治疗后与治疗前比较，# P < 0.05
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表 3 2组患者血液动力学的变化情况比较（$\bar x \pm s $）
Table 3. Comparison of hemodynamic between the two groups （$\bar x \pm s $）
指标 时间 药物联合IABP组（n = 20） 单纯药物治疗组（n = 15） t P 平均动脉压（mmHg） 治疗前 67.6 ± 5.3 64.1 ± 8.6 1.48 0.14 治疗后 75.6 ± 4.3*# 60.6 ± 7.3 2.91 0.021*# 心率（次/min） 治疗前 96.1 ± 12.7 99.6 ± 14.5 0.44 0.65 治疗后 84.2 ± 15.7*# 103.1 ± 9.6 3.21 0.013*# 中心静脉压（ cm H2O） 治疗前 15.6 ± 4.3 16.7 ± 3.7 1.56 0.12 治疗后 11.6 ± 2.8*# 17.7 ± 4.9 2.72 0.023*# 肌酐（μmol/L） 治疗前 127.6 ± 23.5 133.6 ± 25.1 0.47 0.59 治疗后 120.1 ± 16.3* 148.0 ± 26.2 2.36 0.025* 乳酸（mmol/L） 治疗前 2.85 ± 0.5 2.71. ± 0.6 1.35 0.18 治疗后 2.03 ± 0.5*# 3.60 ± 0.8 1.90 0.032*# 注：与单纯药物治疗组治疗后比较， *P < 0.05；治疗后与治疗前比较，#P < 0.05
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表 4 2组患者的短期预后比较[n（%）]
Table 4. Comparison of short-term prognosis between the two groups [n（%）]
组别 n 存活 死亡 药物联合IABP组 20 12（60.0） 8（40.0） 单纯药物治疗组 15 2（13.3） 13（86.7） χ2 − 7.78 P − 0.004
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