急性心肌梗死合并心源性休克應(yīng)用主動脈內(nèi)球囊反搏支持下急診經(jīng)冠狀動脈介入術(shù)的臨床研究

劉志輝　何偉喜　馮驥

[摘要]目的 探討主動脈內(nèi)球囊反搏支持下急診經(jīng)冠狀動脈介入術(shù)治療急性心肌梗死合并心源性休克的臨床效果。方法 選取本院2014年10月～2016年10月急性心肌梗死合并心源性休克患者86例，采用隨機(jī)數(shù)字表法分為兩組，對照組患者43例實施急診經(jīng)冠狀動脈介入術(shù)治療，觀察組患者43例實施主動脈內(nèi)球囊反搏支持下急診經(jīng)冠狀動脈介入術(shù)治療，比較兩組患者治療前后的臨床指標(biāo)改變情況；并發(fā)癥情況、預(yù)后情況。結(jié)果 治療后，兩組患者的平均動脈壓、心排血量、左室射血分?jǐn)?shù)、心臟指數(shù)、每搏輸出量增加（P<0.05）。兩組患者的心肌肌鈣蛋白、肌酸激酶同工酶、心率降低（P<0.05）。觀察組患者的平均動脈壓、心排血量、左室射血分?jǐn)?shù)、心臟指數(shù)、每搏輸出量高于對照組（P<0.05），觀察組患者心肌肌鈣蛋白、肌酸激酶同工酶、心率、總并發(fā)癥發(fā)生率低于對照組（P<0.05）。觀察組患者的預(yù)后情況好于對照組（P<0.05）。結(jié)論 主動脈內(nèi)球囊反搏支持下急診經(jīng)冠狀動脈介入術(shù)治療急性心肌梗死合并心源性休克的效果顯著，可明顯改善患者的臨床病癥與指征，安全性高。

[關(guān)鍵詞]急性心肌梗死；心源性休克；經(jīng)冠狀動脈介入術(shù)

[中圖分類號] R542.2+2 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1674-4721（2017）06（a）-0054-04

[Abstract]Objective To investigate clinical effect of emergency percutaneous coronary intervention with intra aortic balloon pump applied in acute myocardial infarction complicated with cardiogenic shock.Methods 86 patients with cardiogenic shock complicated with acute myocardial infarction treated in our hospital from October 2014 to October 2016 were selected and they were divided into two groups according to the random number table method.43 patients received emergency percutaneous coronary intervention were selected as control group.43 patients received emergency percutaneous coronary intervention with intra aortic balloon pump were selected as observation group.Change of clinical indicators before and after treatment，complications，prognosis were compared between two groups.Results After treatment，mean arterial pressure，cardiac output，left ventricular ejection fraction，cardiac index，stroke volume increased in two groups （P<0.05）.Cardiac troponin，creatine kinase isoenzyme，heart rate decreased in two groups （P<0.05）.Mean arterial pressure，cardiac output，left ventricular ejection fraction，cardiac index，stroke volume in observation group were higher than control group （P<0.05）.Cardiac troponin，creatine kinase isoenzyme，heart rate，the total incidence rate of complication in observation group were lower than control group.Prognosis in observation group was better than that in control group （P<0.05）.Conclusion Emergency percutaneous coronary intervention with intra aortic balloon pump has significant effect int reatment of cardiogenic shock complicated with acute myocardial infarction，which can significantly improve clinical symptoms and signs and it also has high safety.

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

急性心肌梗死合并心源性休克是臨床常見的一種急危重癥，病死率可高達(dá)60%～70%[1-2]，而老年人身體狀況更差，病死率可能更高。臨床治療急性心肌梗死合并心源性休克的常用方法為經(jīng)冠狀動脈介入術(shù)[3-4]，該方法可迅速、完全、持續(xù)的開通梗死部位相關(guān)血管，有效恢復(fù)機(jī)體冠狀動脈血流，挽救患者瀕死的心肌，發(fā)揮保護(hù)心臟的功能，從而提高治療成功率，并改善患者的預(yù)后。但由于存在血流動力學(xué)改變，手術(shù)風(fēng)險增加，仍具有較高病死率。主動脈內(nèi)球囊反搏術(shù)可在一定程度上改善患者的心肌供氧，有助于提高心功能，擴(kuò)大手術(shù)療效[5-7]。本研究探討主動脈內(nèi)球囊反搏支持下急診經(jīng)冠狀動脈介入術(shù)治療急性心肌梗死合并心源性休克的臨床療效，現(xiàn)報道如下。……