Scully H E, Gunstensen J, Williams W G, Adelman A A, Baigre R S, Goldman B S
Surgery. 1976 Oct;80(4):437-42.
Acute coronary insufficiency (ACI) has a one year mortality rate approximating 40 percent with medical treatment alone. This report reviews our experience over 24 months with preoperative intra-aortic balloon pump assist (IABPA) in 42 patients with ACI. Abnormal left ventricular (LV) hemodynamics were present in the majority of patients; the ejection fraction was less than 40 percent in 14 patients. The endocardial viability ratio (EVR) was less than 0.7 in eight patients. The mean coronary artery score was 13, compared to 9 in an otherwise comparable group of patients with stable angina. Left main coronary stenosis greater than 75 percent was present in seven patients and combined with significant stenosis (less than 72 percent) in the dominant right system in four patients. Four patients had proximal stenoses greater than 90 percent in all three major coronary arteries. IABPA was initiated in 11 patients prior to angiography because of refractory rest pain. One of these six patients died. Twenty-five other patients were supported before and six after induction of general anesthesia. Thirty-three of 36 revascularized patients survived. Of four patients with perioperative myocardial infarctions (12 percent), three had IABPA after induction of general anesthesia. Inotropic support and duration of stay both in intensive care and in the hospital were less than in similar patients treated before the use of IABPA.
单纯药物治疗的急性冠状动脉供血不足（ACI）患者一年死亡率约为40%。本报告回顾了我们在24个月内对42例ACI患者进行术前主动脉内球囊泵辅助（IABPA）的经验。大多数患者存在左心室（LV）血流动力学异常；14例患者射血分数低于40%。8例患者的心内膜活力比（EVR）低于0.7。冠状动脉平均积分为13分，而在一组情况类似的稳定型心绞痛患者中该积分为9分。7例患者左主干冠状动脉狭窄大于75%，4例患者合并优势右冠状动脉系统显著狭窄（小于72%）。4例患者所有三支主要冠状动脉近端狭窄均大于90%。11例患者因顽固性静息性疼痛在血管造影术前开始使用IABPA。这6例患者中有1例死亡。另外25例患者在全身麻醉诱导前及6例在全身麻醉诱导后接受了IABPA支持。36例接受血运重建的患者中有33例存活。4例围手术期心肌梗死患者（12%）中，3例在全身麻醉诱导后接受了IABPA。与在使用IABPA之前治疗的类似患者相比，使用正性肌力药物支持以及在重症监护病房和住院的时间均有所缩短。
