主动脉内球囊反搏术球囊放置时机对非体外循环冠状动脉旁路移植患者早期预后的影响

摘要

Objective To explore the impact of intra-aortic balloon pump (IABP) support timing on the early prognosis of patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods A total of 161 OPCABG patients who were treated with IABP from November 2015 to May 2016 in Beijing Anzhen Hospital,Capital Medical University were enrolled.Group A (n =37) had IABP before surgical operation.Group B (n =124) had IABP during or after surgery due to disease condition.Basic clinical data and surgical records were analyzed between groups.Results Preoperative basic data,operation time and bypass numbers showed no significant differences between groups(P ＞ 0.05).Use rate of internal mammary artery in group A was significantly higher and incidences of low cardiac output syndrome,acute kidney injury and newly developed atrial fibrillation were significantly lower than those in group B(P ＜ 0.05).Rates of continuous renal replacement therapy,lower extremity ischemia of IABP side,newly developed stroke,extracorporeal membrane oxygenation support due to severe circulation failure and death showed no significant differences between groups (P ＞ 0.05).Mechanical ventilation time and intensive care unit stay time in group A were significantly shorter than those in group B[(33 ± 13)h vs (47 ±28)h,(3.8 ± 1.4)d vs(4.7 ± 2.3) d] (P ＜ 0.05).Conclusion Prophylactic treatment with IABP can shorten mechanical ventilation and intensive care unit residence,reduce acute renal injury and perioperative mortality in OPCABG patients.%目的 探讨主动脉内球囊反搏(IABP)术球囊放置时机对非体外循环冠状动脉旁路移植(OPCABG)患者早期预后的影响.方法 选择2015年11月至2016年5月在首都医科大学附属北京安贞医院接受IABP辅助OPCABG患者161例,将患者按IABP球囊放置时机分为手术前放置组(A组,37例)和术中及术后因病情需要放置组(B组,124例),比较2组患者术前一般资料和手术情况.结果 2组患者术前资料和手术时间、搭桥支数比较差异均无统计学意义(均P ＞0.05);A组患者内乳动脉使用率高于B组,术后低心排血量综合征、急性肾损伤、新发心房颤动发生率低于B组,差异均有统计学意义(均P＜0.05),但2组患者肾功能损伤需连续性肾脏替代治疗、IABP侧下肢缺血、新发脑卒中、严重循环衰竭需体外膜肺氧合辅助比例和病死率比较差异均无统计学意义(均P ＞0.05);A组呼吸机辅助时间、住重症监护病房时间均短于B组[(33±13)h比(47±28)h,(3.8±1.4)d比(4.7±2.3)d],差异均有统计学意义(均P＜0.05).结论 对于高危OPCABG患者手术前预防性放置IABP球囊有降低围术期病死率的趋势,并缩短患者机械通气及重症监护病房停留时间,减少急性肾损伤的发生.