AMI 并发心源性休克患者在 IABP 支持下行急诊PCI 对术后炎性因子水平的影响

摘要

目的：探讨急性心肌梗死（AMI）并发心源性休克患者行急诊经皮冠状动脉介入术（PCI）治疗时主动脉内球囊反搏（ IABP）对术后炎性因子水平的影响。方法应用IABP支持下进行急诊PCI治疗的AMI并发心源性休克患者46例为观察组，以同期收治未应用IABP支持下采用急诊PCI治疗的AMI并发心源性休克患者32例为对照组，分别观察患者术前、术后3、7 d时的C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平变化，术前、术后2周、术后3个月时的左心室射血分数（ LVEF）变化及患者病死率。结果观察组与对照组在AMI分类、病变位置、病变累及分支及置入支架数方面比较差异无统计学意义（ P ＞0．05），观察组住院时间短于对照组（P ＜0．05）；观察组患者IABP时间平均为（84．12±34．74）h，2组术前CRP、TNF-α、IL-6水平及LVEF比较差异无统计学意义（ P ＞0．05），术后3、7 d时2组CRP、TNF-α、IL-6水平均升高（ P ＜0．05），且观察组明显低于对照组（ P ＜0．05），LVEF术后2周、3个月时观察组明显高于对照组（ P ＜0．05），术后3个月内病死率观察组明显低于对照组（30．43％vs．56．25％， P ＜0．05）。结论合并心源性休克的AMI患者在急诊行PCI治疗时联合IABP治疗能明显降低术后炎性因子水平，改善左心室功能，降低术后近期病死率。%Objective To investigate the effect of emergency percutaneous coronary intervention ( PCI)treatment of intra-aortic balloon counterpulsation ( IABP) on the levels of inflammatory factors in postoperative patients with acute myocar -dial infarction ( AMI) complicated by cardiogenic shock .Methods 46 cases of observation group were AMI patients with car-diogenic shock , IABP support for application of emergency PCI for the treatment , during the same period , 32 cases of patients with AMI complicated by cardiogenic shock as the control group did not apply to the use of IABP support received the treat -ment of primary PCI , preoperative , after 3 and 7 d, C-reactive protein ( CRP) , tumor necrosis factor-α( TNF-α) , interleu-kin-6 (IL-6) were observed, preoperative and 2 weeks postoperative, three months after treatment, left ventricular ejection fraction when LVEF changes and patient mortality were observed .Results Observation group and control group in AMI classi-fication, lesion location , number of lesions involving the branches and stent implantation showed relatively no significant difference ( P >0.05), observation group showed shorter hospital stay than the control group ( P <0.05); The patients IABP average of (84.12 ±34.74) h, 2 groups preoperative CRP , TNF-α, IL-6 levels and LVEF was not significant differ-ence ( P >0.05), after 3 and 7 d, 2 groups'CRP, TNF-α, IL-6 levels were elevated ( P <0.05), but the observation group was significantly lower than the control group ( P <0.05), after 2 weeks, 3 months LVEF of the observation group was significantly higher ( P <0.05), mortality within 3 months after treatment, the observation group was significantly lower than the control group (30.43%vs.56.25%, P <0.05).Conclusion AMI patients with cardiogenic shock treated with PCI at the time of the emergency joint IABP therapy can significantly reduce postoperative inflammatory cytokine levels , improve left ventricular function and reduce postoperative mortality .