摘要
目的比较不同时机主动脉内球囊反搏(IABP)置入对高危冠状动脉粥样硬化性心脏病(冠心病)患者行冠状动脉旁路移植术(CABG)围术期预后的影响。方法回顾性分析河南省人民医院心血管外科成人监护室于2015年1月～2017年3月收治的136例高危冠心病行CABG且围术期应用IABP辅助患者的临床资料。根据IABP置入时间将其分为:术前置入组(n=48)和术中、术后置入组(n=88),分别比较两组患者机械通气时间、ICU停留时间、住院总花费、住院死亡率等围术期指标。结果两组患者年龄、男性患者比例、吸烟比例、术前NYHA心功能≥Ⅲ级患者比例、术前左心室射血分数、术中搭桥的桥血管数目及是否行体外循环患者比例均未见明显差异(P>0.05)。术前IABP置入组患者IABP应用时间[(45.3±22.1)h vs.(76.1±25.3)h]、机械通气时间[(48.8±16.2)h vs.(71.3±29.3)h]及ICU停留时间[(65.2±15.2)h vs.(98.2±19.6)h]均明显短于术中、术后IABP置入组(P<0.05),且术前IABP置入组患者平均住院花费[(13.2±7.8)万元vs.(18.6±9.2)万元]明显低于术中、术后IABP置入组,差异均有统计学意义(P<0.05)。术前置入IABP组患者住院死亡率明显低于术中、术后置入IABP患者(8.3%vs.25.0%),差异具有统计学意义(P<0.05)。结论对于高危冠心病患者拟行CABG,术前预防性置入IABP是安全和有效的,其能够降低患者住院死亡率,缩短ICU停留时间,且具有相对较少的住院花费。
Objective To compare the perioperative outcomes on different timing of intra-aortic balloon pump(IABP)implantation of patient who with high risk coronary artery disease and undergoing coronary artery bypass grafting(CABG).Methods A total of136high risk coronary artery disease patients who performed CABG with IABP in Fuwai Central China Cardiovascular Hospital from January2015to March2017were retrospectively analyzed.According to IABP placement time,they were divided into preoperative placement group(n=48)and intraoperative and postoperative implantation group(n=88).The mechanical ventilation time,ICU stay time,total hospitalization cost and hospital mortality were compared between the two groups.Results There is no significant difference in the age of the two groups,the proportion of male patients,the proportion of patients who smoked,the proportion of preoperative NYHA patients with cardiac function≥Ⅲ,the preoperative left ventricular ejection fraction,the number of bridge vessels in the bypass,and the proportion of patients undergoing cardiopulmonary bypass(P>0.05).IABP application time in preoperative placement group[(45.3±22.1)h vs.(76.1±25.3)h],mechanical ventilation time[(48.8±16.2)h vs.(71.3±29.3)h]and ICU residence time[(65.2±15.2)h vs.(98.2±19.6)h]were significantly shorter than the intraoperative and postoperative placement group(P<0.05),and the average hospitalization cost of preoperative placement group[(13.2±7.8)10,000yuan vs.(18.6±9.2)yuan]significantly lower than the intraoperative and postoperative placement group,the difference was statistically significant(P<0.05).The hospital mortality rate of preoperative placement group was significantly lower than that of the intraoperative and postoperative placement group(8.3%vs.25.0%),the difference was statistically significant(P<0.05).Conclusion Preoperative IABP placement was safe and helpful for patient with high risk coronary artery disease.Preoperative preventative implantation of IABP in high-risk patients significantly reduced hospital
作者
孟树萍
程兆云
胡延磊
丁付燕
李晓慧
刘超
王晓航
刘富荣
Meng Shuping;Cheng Zhaoyun;Hu Yanlei;Ding Fuyan;Li Xiaohui;Liu Chao;Wang Xiaohang;Liu Furong(Center for Cardiac Intensive Care Unit,Fuwai Central China Cardiovascular Hospital,Henan Province's People Hospital,Zhengzhou 450000,China)
出处
《中国循证心血管医学杂志》
2018年第11期1315-1317,1321,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
河南省医学科技攻关计划省部共建项目(201601011)
关键词
主动脉内球囊反搏
冠状动脉搭桥术
置入时机
Intra-aortic balloon pump
Coronary artery bypass grafting
Optimal time
