急診介入聯合IABP治療急性心肌梗死合并心源性休克的臨床觀察

郭林

[摘要] 目的 探討急診介入聯合主動脈內球囊反搏（Intra-aortic balloon pump或Intraaortic Balloon Counterppulsation，IABP）治療急性心肌梗死合并心源性休克的臨床效果。 方法 選取2012年2月～2017年1月在我院確診的急性心肌梗死合并心源性休克患者40例作為研究對象，采用隨機分組的方式分為對照組和實驗組，每組20例。實驗組在IABP支持下，實施急診經冠狀動脈介入術，對照組實施急診經冠狀動脈介入術。治療后比較兩組患者的臨床指標變化情況及出現并發癥概率、死亡率。 結果 治療后兩組患者心排血量、平均動脈壓、心臟指數、左室射血分數、每搏輸出量等指標上升，肌酸激酶同工酶、心肌肌鈣蛋白和心率指標均降低，兩組治療后結果對比差異有統計學意義（P<0.05），且治療后實驗組患者的指標改善幅度明顯優于對照組；實驗組患者預后出現并發癥概率顯著低于對照組，且死亡率明顯低于對照組，差異有統計學意義（P<0.05）。 結論 急診介入聯合IABP治療急性心肌梗死合并心源性休克的臨床效果顯著，值得在臨床上推廣應用。

[關鍵詞] 急診經冠狀動脈介入術；IABP；急性心肌梗死；心源性休克

[中圖分類號] R542.22 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0098-03

[Abstract] Objective To investigate the clinical effect of emergency intervention combined with intra-aortic balloon pump（IABP） in the treatment of acute myocardial infarction complicated with cardiogenic shock. Methods 40 patients with acute myocardial infarction and cardiogenic shock diagnosed in our hospital from February 2012 to January 2017 were selected as the study objects and randomly divided into control group（n=20） and experimental group（n=20）. The patients in the experimental group underwent emergency PCI under the support of IABP. The patients in the control group were treated with emergency PCI. After treatment， the clinical indicators the probability of complications and mortality between the two groups were compared. Results The indicators cardiac output， mean arterial pressure， cardiac index， left ventricular ejection fraction and stroke volume after treatment were increased， and the creatine kinase isoenzyme， cardiac troponin and heart rate index were decreased， there was signifcant difference between the two groups after treatment（P<0.05）. The improvement magnitude in the experimental group was better than that in the control group after treatment. The probability of complications in the prognosis of patients in the experimental group was significantly lower than that in the control group， and the mortality in the experimental group was significantly lower than that in the control group. There was significant difference between the two groups（P<0.05）. Conclusion The emergency intervention combined with IABP in the treatment of acute myocardial infarction complicated with cardiogenic shock has significant clinical effect and is worthy of popularizing in clinic.

[Key words] Emergency coronary intervention； IABP； Acute myocardial infarction； Cardiogenic shock

急性心肌梗死合并心源性休克在臨床上很常見，是一種急危重癥，致死率較高。在目前臨床治療中，實施急診經冠狀動脈介入術是治療急性心肌梗死合并心源性休克疾病有效的治療方法[1，2]。這種治療方法可以快速和精確地打通患者梗死部位處血管，但是血流動力學的存在使這種治療方法有一定的風險，還有較高的死亡率。而IABP的介入可以在一定程度上提高患者的心功能，在IABP支持下，實施經冠狀動脈介入術可降低手術的風險[3，4]。本研究以40例急性心肌梗死合并心源性休克患者為研究對象，探討急診介入聯合IABP治療急性心肌梗死合并心源性休克的臨床效果，現報道如下。……