【摘要】 目的探讨术前主动置入和术中/术后被动置入主动脉内球囊反搏(intra-aortic balloon pump,IABP)对高危冠状动脉旁路移植术(coronary artery bypass graft,CABG)患者的应用价值。方法回顾性分析2010年3月~2012年12月我院高危CABG患者围手术期使用IABP 90例资料,根据IABP置入的时机将患者分为A、B两组。A组31例,术前预防性使用IABP;B组59例,术中或术后应用IABP。比较2组围手术期表现及随访期间主要心脑血管事件(major adverse cardiac or cerebrovascular events,MACCE)的差异。结果与B组相比,A组ICU停留时间短[(70.2±50.5)h vs.(123.2±95.8)h,t=-3.436,P=0.010];术后IABP支持时间(入ICU到IABP撤离)短[(21.8±13.9)h vs.(65.6±25.3)h,t=-10.576,P=0.000];术后房颤少[0%(0/31)vs.23.7%(14/59),P=0.002];术后急性肾损伤少[19.4%(6/31)vs.50.8%(30/59),χ2=8.398,P=0.004]。随访(30.0±12.3)月,MACCE两组比较无显著性差异。结论术前合理使用IABP,使CABG高危风险患者有良好的近期效果。更多还原

【Abstract】 Objective To investigate the effects of intra- or post-operative preventative intra-aortic balloon pump( IABP)insertion in high risk coronary artery bypass patients. Methods From March 2010 to December 2012,90 consecutive patients undergoing coronary artery bypass graft( CABG) with IABP support were observed. The group A included 31 patients with preoperative IABP insertion,and the group B included 59 intra- or post-operative IABP insertion. Peri-operative clinical data and major adverse cardiac or cerebrovascular events( MACCE) during follow-ups were compared between the two groups. Results The ICU stay time was shorter significantly in the group A than in the group B [( 70. 2 ± 50. 5) h vs.( 123. 2 ± 95. 8) h,t =- 3. 436,P = 0. 010]. The postoperative IABP support time in the group A was shorter than that in the group B [( 21. 8 ± 13. 9) h vs.( 65. 6 ± 25. 3) h,t =- 10. 576,P = 0. 000]. The postoperative atrial fibrillation rate was lower in the group A than in the group B [0%( 0 /31) vs.23. 7%( 14 /59),P = 0. 002]. The postoperative acute kidney injury( AKI) rate was significant lower in the group A than in the group B [19. 4%( 6 /31) vs. 50. 8%( 30 /59),χ2= 8. 398,P = 0. 004]. During follow-ups for( 30. 0 ± 12. 3) months,there were no differences in MACCE rate between the two groups. Conclusion Preventive preoperative use of IABP may help improve early outcomes in high risk CABG patients.更多还原