急性心肌梗死合并心源性休克应用主动脉内球囊反搏支持下急诊经冠状动脉介入术的临床研究

刘志辉　何伟喜　冯骥

[摘要]目的 探讨主动脉内球囊反搏支持下急诊经冠状动脉介入术治疗急性心肌梗死合并心源性休克的临床效果。方法 选取本院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，采用随机数字表法分为两组，对照组患者43例实施急诊经冠状动脉介入术治疗，观察组患者43例实施主动脉内球囊反搏支持下急诊经冠状动脉介入术治疗，比较两组患者治疗前后的临床指标改变情况；并发症情况、预后情况。结果 治疗后，两组患者的平均动脉压、心排血量、左室射血分数、心脏指数、每搏输出量增加（P<0.05）。两组患者的心肌肌钙蛋白、肌酸激酶同工酶、心率降低（P<0.05）。观察组患者的平均动脉压、心排血量、左室射血分数、心脏指数、每搏输出量高于对照组（P<0.05），观察组患者心肌肌钙蛋白、肌酸激酶同工酶、心率、总并发症发生率低于对照组（P<0.05）。观察组患者的预后情况好于对照组（P<0.05）。结论 主动脉内球囊反搏支持下急诊经冠状动脉介入术治疗急性心肌梗死合并心源性休克的效果显著，可明显改善患者的临床病症与指征，安全性高。

[关键词]急性心肌梗死；心源性休克；经冠状动脉介入术

[中图分类号] R542.2+2 [文献标识码] A [文章编号] 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临床常见的一种急危重症，病死率可高达60%～70%[1-2]，而老年人身体状况更差，病死率可能更高。临床治疗急性心肌梗死合并心源性休克的常用方法为经冠状动脉介入术[3-4]，该方法可迅速、完全、持续的开通梗死部位相关血管，有效恢复机体冠状动脉血流，挽救患者濒死的心肌，发挥保护心脏的功能，从而提高治疗成功率，并改善患者的预后。但由于存在血流动力学改变，手术风险增加，仍具有较高病死率。主动脉内球囊反搏术可在一定程度上改善患者的心肌供氧，有助于提高心功能，扩大手术疗效[5-7]。本研究探讨主动脉内球囊反搏支持下急诊经冠状动脉介入术治疗急性心肌梗死合并心源性休克的臨床疗效，现报道如下。……