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目的探讨主动脉内球囊反搏(IABP)置入辅助时机对老年急性心肌梗死合并心源性休克患者临床疗效的影响。方法连续选择自2011年1月~2014年3月心内科收治的116例年龄大于65岁的IABP辅助治疗急性心肌梗死合并心源性休克的患者,按照心源性休克发生至IABP置入的时间,将其分为两组,A组(n=53)为心源性休克至IABP置入时间小于等于3 h,B组(n=63)为大于3 h;观察血运重建、多巴胺使用情况,并记录总IABP辅助时间,30 d内全因死亡、急性呼吸衰竭、急性肾功能衰竭、主要出血事件等临床事件。结果多巴胺使用无统计学差异。平均IABP辅助时间A组低于B组(71.0 h vs.128.5h,P<0.01);A组与B组相比,全因死亡两组间有统计学差异(15.1%vs.31.7%,P<0.05);心源性死亡(13.2%vs.25.4%,P=0.10)、急性呼吸衰竭发生率(26.4%vs.34.9%,P=0.32)、急性肾功能衰竭发生率(11.3%vs.20.6%,P=0.18)、主要出血事件(5.7%vs.11.1%,P=0.29)有降低的趋势,但无统计学意义。结论在老年急性心肌梗死合并心源性休克的患者早期应用IABP辅助治疗可能有助于改善30 d内生存率以及减少主要临床事件的发生率。
Objective To investigate the effect of intra-aortic balloon pump (IABP) insertion on the clinical efficacy of elderly patients with acute myocardial infarction complicated by cardiogenic shock. Methods A total of 116 IABP-assisted patients with acute myocardial infarction and cardiogenic shock who were admitted to our department of cardiology from January 2011 to March 2014 were selected according to the duration of cardiogenic shock to IABP (N = 53), the time from cardiogenic shock to IABP was less than or equal to 3 h, while that of group B (n = 63) was more than 3 h. The effects of revascularization, dopamine use , And recorded the total IABP auxiliary time, all-cause death within 30 days, acute respiratory failure, acute renal failure, major bleeding and other clinical events. Results There was no statistical difference in dopamine use. The average IABP auxiliary time in group A was lower than that in group B (71.0 h vs.128.5 h, P <0.01). There was a significant difference in all-cause death between group A and group B (15.1% vs.31.7%, P (P <0.05). The incidence of acute renal failure (13.2% vs.25.4%, P = 0.10), acute respiratory failure (26.4% vs.34.9%, P = 0.32) and acute renal failure (11.3% vs. 20.6%, P = 0.18). The main bleeding events (5.7% vs.11.1%, P = 0.29) showed a trend of decreasing but not statistically significant. Conclusion The early application of IABP adjuvant therapy in elderly patients with acute myocardial infarction complicated with cardiogenic shock may help to improve the survival rate within 30 days and reduce the incidence of major clinical events.