【摘要】 目的本项研究主要探讨治疗急性心肌梗死(AMI)合并心源性休克(CS)时主动脉球囊反搏(IABP)联合或不联合急诊经皮冠状动脉支架术对院内病死率的影响。方法选取77例(男性67例,女性10例)2006年1月～2012年10月期间置入IABP的AMI并发CS病例,分成两组,A组(n=47)为行支架术组,B组(n=30)由于血栓负荷重、复杂多支或严重狭窄病变未行支架术组。观察指标为狭窄血管数目,术后罪犯血管远端血流TIMI分级,在院死亡。结果冠脉造影结果:3支病变发生率:A组31.9%,B组63.3%,有统计学差异(P=0.01),两组术后罪犯血管远端血流TIMI<3级:A组10.6%,B组26.7%,无统计学差异(P=0.20)。在院病死率:A组44.7%,B组56.7%,总病死率49.3%,无统计学差异(P=0.39)。多变量Logistic回归模型分析显示,术后罪犯血管远端血流TIMI<3级(OR=2.14,95%CI:1.76～41.40)可作为AMI合并CS病人在院死亡独立危险因素。结论急诊介入治疗AMI合并CS,支架术或未行支架术的预后可能取决于术后冠状动脉的再灌注,术后罪犯血管远端血流TIMI<3级可作为AMI合并CS病人在院死亡的独立预测因素。更多还原

【Abstract】 Objective To explore the influence of aortic balloon counterpulsation(IABP) with emergency percutaneous coronary artery stenting or non-stenting on hospital mortality of acute myocardial infarction(AMI) with cardiac shock(CS).Methods Totally 77 cases(67 males,10 females) of AMI with CS supported by IABP from January 2006 to October 2012 were divided into 2 groups:group A(n=47) with stenting,group B(n=30) with non-stenting because of heavy thrombosis,seriously narrow artery or multi-branch lesions.The number of stenosis coronary artery,postoperative TIMI grade of distal culprit vessel,hospital mortality were observed.Results Coronary angiography showed that three branch lesions in A group and B group was 31.9% and 63.3% respectively(P=0.01).The postoperative TIMI grade of distal culprit vessel in A group and B group was 10.6% and 26.7% respectively(P=0.20).Mortality of group A and group B was 44.7% and 56.7%(P=0.39).Multiple logistic regression model analysis identified the postoperative TIMI<3 of distal culprit vessel(OR=2.14;95% CI:1.76~41.40) as independent predictor of hospital death for AMI with CS.Conclusion The prognosis of stenting or non-stenting was related with coronary artery perfusion.The postoperative TIMI<3 of distal culprit vessel was independent predictors of hospital death for AMI with CS.更多还原