主动脉内气囊反搏对急性ST段抬高型心肌梗死伴心源性休克患者急性肾损伤的影响

发布时间：2018-03-02 11:00

本文关键词： 主动脉内气囊反搏急性ST段抬高型心肌梗死心源性休克急性肾损伤　出处：《中国动脉硬化杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的探讨主动脉内气囊反搏(IABP)对急性ST段抬高型心肌梗死(STEMI)伴心源性休克(CS)患者肾功能的影响。方法 STEMI伴CS患者103例,随机分为对照组(n=51)和IABP组(n=52),比较两组患者的临床资料,观察STEMI伴CS患者急性肾损伤(AKI)的发生率、严重程度和30天的存活率,以及IABP对AKI的影响。结果两组间年龄、性别、高血压病史、糖尿病史、合并肺水肿、入院收缩压、入院平均动脉压、心率、左心室射血分数、血肌酐基础值、基础肾小球滤过率估计值、门-球时间、对比剂用量及术后TIMI血流等指标比较无显著差异(P0.05)。在静脉使用多巴胺剂量及去甲肾上腺素使用率方面,IABP组低于对照组(P0.05)。对照组AKI主要发生在第1天,而IABP组更多发生在第2天,两组AKI总体发生率比较无显著差异(P0.05)。肾替代治疗(RRT)比较,对照组高于IABP组(35.3%比17.3%,P0.05)。血肌酐比较,第1天对照组的血肌酐高于IABP组(P0.05),而入院基础值、第2天和第3天两组均无显著差异。30天存活率比较,对照组和IABP组无显著差异,而AKI患者低于非AKI患者(P0.01)。结论 IABP不减少STEMI伴CS患者AKI的发生率,也不提高其30天存活率,但能延缓AKI进展的速度,减少AKI患者的RRT使用率。
[Abstract]:Objective to investigate the effect of intraaortic balloon counterpulsation on renal function in patients with acute ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock. Methods 103 patients with STEMI with CS were randomly divided into two groups: control group (n = 51) and IABP group (n = 52). The incidence, severity and 30-day survival rate of acute renal injury (ABI) in patients with STEMI with CS and the effect of IABP on AKI were observed. Results Age, sex, history of hypertension, history of diabetes, pulmonary edema, and systolic blood pressure were observed between the two groups. Mean arterial pressure, heart rate, left ventricular ejection fraction, serum creatinine base value, estimated basal glomerular filtration rate, gate-ball time, There was no significant difference in the dosage of contrast agent and the blood flow of TIMI after operation. The dosage of dopamine and the utilization rate of norepinephrine were significantly lower in the control group than in the control group. AKI occurred mainly on the first day in the control group, but more in the IABP group on the second day. There was no significant difference in the overall incidence of AKI between the two groups (P 0.05). Compared with IABP group, the total incidence of AKI in the control group was higher than that in the IABP group (35. 3% vs 17. 03%, P 0. 05). The serum creatinine in the control group was higher than that in the IABP group on the first day, but the baseline value of admission was higher than that in the control group. There was no significant difference between the two groups on the second day and the third day. There was no significant difference between the control group and the IABP group, but the AKI group was lower than that in the non-#en2# group (P 0.01). Conclusion IABP does not decrease the incidence of AKI in STEMI patients with CS, nor does it improve the 30-day survival rate. But it can delay the progress of AKI and reduce the RRT usage rate in AKI patients.
【作者单位】：湖南省人民医院湖南师范大学附属第一医院心内科;
【基金】：湖南省教育厅项目(14C0702)
【分类号】：R542.22;R692

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