摘要
目的评估急性心肌梗死(acute myocardial infarction,AMI)合并心源性休克(cardiogenic shock,CS)患者经肱动脉与股动脉路径进行主动脉内球囊反搏术(TBA-IABP与TFA-IABP)的有效性及安全性。方法纳入2010年6月至2011年12月期间在广东医学院附属医院行TBA-IABP及TFA-IABP治疗的AMI合并CS患者95例,将患者随机分为TBA-IABP组(46例)和TFAIABP组(49例)。比较两组患者住院期间临床事件的发生率。结果与TFA-IABP组相比,TBAIABP组IABP开始工作至CS缓解时间、总住院时间、穿刺点压迫时间均降低[(44±10.6)h比(65±12.5)h;(154±26.6)h比(236±34.2)h;(3±1.6)min比(25±10.2)min,P均<0.05];TBA-IABP组迷走神经反射、血肿和假性动脉瘤发生率也较TFA-IABP组低(2%比10%;2%比8%;0比4%,P均<0.05);相应TBA-IABP组CS抢救成功率明显高于TFA-IABP组(87%比73%,P=0.047)。TBA-IABP组有2例出现轻度远端肢体血运欠佳,但经解痉镇痛症状缓解。结论对AMI合并CS患者,TBA-IABP的血管并发症发生少,且CS抢救成功率高,其机制可能与TBAIABP有利于局部压迫止血、无体位限制(患者可半坐卧位)、患者痛苦小和心理压力轻(减少交感神经张力)有关,作为可选择的血管路径之一。
Objective Compare the efficacy and safety of transbrachial insertion of intra- aortic balloon pump （TBA-IABP） with transfemoral insertion of IABP （TFA-IABP） in acute myocardial infarction （AMI） patients with cardiogenic shock（CS）. Methods From June 2010 to December 2011, patients receiving TBA-IABP or TFA-IABP in our center were screened and enrolled into this study. There were 46 patients in the TBA-IABP group and 49 patients in the TFA-IABP group. The Incidences of in hospital clinical events of the two groups were compared. Results Compared with TFA-IABP, the point of puncture ligature time, total hospital stay and CS ease time after IABP reduced in the TBA-IABP [（44±10.6） h vs. （65±12.5）h; （154±26.6） h vs. （236±34.2） h; （3±1.6） min vs. （25±10.2） min, respectively P 〈 0.05）]. The rates of vasovagal reflex, hematoncus and pseudoaneurysm decreased in the TBA-IABP （2% vs. 10%; 2% vs. 8%; 0 vs. 4%, respectively P 〈 0.05）. TBA-IABP improvd the effective rate in treating CS. Slight artery spasm happened in 2 cases in the TBA-IABP group during the procedure of IABP but the procedure was continued with administration of medicine to release the spasm. Conclusions For AMI patients with CS, treatment duration of both artery accesses for IABP was similar. The incidence of complications in the TBA-IABP group decreased but the effective rate in treating CS increased. Its mechanisms can related to local oppression to stop bleeding, No body position limit （patients can be semi-supine）, less pain and less psychological stress （reduce the sympathetic nervous tension）.
出处
《中国介入心脏病学杂志》
2014年第2期106-110,共5页
Chinese Journal of Interventional Cardiology
基金
中国医师协会阳光心血管研究基金项目(SCRFCMDA201232)
关键词
主动脉内球囊反搏术
肱动脉
股动脉
急性心肌梗死
心源性休克
Intra-aortic ballon pump
Brachialartery
Transfemoralartery
Acute myocardialinfarction
Cardiogenic shock
