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目的:探讨急性心肌梗死(AMI)后休克患者主动脉内球囊反搏(IABP)辅助治疗时机的选择对治疗效果的影响。方法:AMI并休克患者85例,按IABP应用的时机不同随机分为两组:即刻IABP组(43例)为入院时确诊后立即行IABP术,必要IABP组(42例)为经过积极药物治疗后,收缩压仍然<90mmHg(1mmHg=0.133kPa),再行IABP术。比较两组术后1周以及3个月的生存率,测量两组术后1d、3个月的左室射血分数(LVEF),比较两组术前及术后1周的NT-proBNP。结果:必要IABP组术后3个月生存率明显低于术后1周(57.1%∶69.0%),并低于即刻IABP组(67.4%),均具有显著差异(P<0.05)。术后3个月两组的LVEF值均进行性降低,必要IABP组下降幅度大于即刻IABP组[(7.6±3.5)%∶(4.2±3.1)%,P<0.05]。术后1周两组NTproBNP均明显降低,即刻IABP组下降幅度大于必要IABP组[(7 991±3 375)pg/ml∶(5 089±3 120)pg/ml,P<0.05]。结论:AMI并休克患者尽早使用IABP,能降低全因死亡率,保护左室收缩功能。
Objective: To investigate the effect of the timing of adjuvant therapy of intra-aortic balloon pump (IABP) on the therapeutic effect in patients with acute myocardial infarction (AMI) after shock. Methods: Eighty-five patients with AMI and shock were randomly divided into two groups according to the timing of IABP. Immediate IABP group (43 cases) was performed IABP immediately after diagnosis, and the necessary IABP group (42 cases) After the systolic blood pressure was still <90mmHg (1mmHg = 0.133kPa), then IABP surgery. The survival rates of the two groups were compared at 1 week and 3 months after operation. The left ventricular ejection fraction (LVEF) at 1 and 3 months after operation was measured. NT-proBNP was compared between the two groups before and after 1 week. Results: The survival rate of the necessary IABP group after 3 months was significantly lower than that of the IABP group (57.1%: 69.0%) and lower than that of the immediate IABP group (67.4%) (P <0.05). The LVEF values of both groups decreased progressively at 3 months after operation, and the extent of decrease in the necessary IABP group was larger than that of the immediate IABP group (7.6 ± 3.5% vs 4.2 ± 3.1%, P <0.05). NTproBNP was significantly decreased in both groups at 1 week after operation, and the decrease in IABP group was significantly greater than that of the necessary IABP group [(7991 ± 3757) pg / ml: (5 089 ± 3 120) pg / ml, P <0.05] Conclusion: The use of IABP as soon as possible in patients with AMI and shock can reduce all-cause mortality and protect left ventricular systolic function.