Georgeson S, Coombs A T, Eckman M H
Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts 02111.
Am J Med. 1992 Jun;92(6):665-78. doi: 10.1016/0002-9343(92)90785-a.
As the indications for the intra-aortic balloon pump (IABP) continue to evolve, a potential new use may be the prophylactic preoperative insertion of the IABP in the high-risk cardiac patient undergoing noncardiac surgery. Our objective is to present a general approach to the high-risk cardiac patient who may benefit from the prophylactic insertion of the IABP.
Case reports and a decision analysis.
A decision model was constructed that weighs the risk of life-threatening postoperative complications against the risk of vascular complications, including surgery and possible amputation, from IABP insertion.
A review of the literature identified 10 patients who underwent IABP placement prior to noncardiac surgery. These patients, along with our three cases, define a population of patients for whom the prophylactic IABP may be useful. This population includes patients with coronary artery disease (CAD) for whom bypass grafting is not an option due to: (1) inoperable CAD; (2) a severe coexisting disease process (such as a malignancy); or (3) the emergent nature of the noncardiac procedure. The decision analysis suggests that patients whose preoperative assessment places them at very high risk for postoperative complications (Goldman class IV or Detsky class III undergoing major surgery) may benefit the most from prophylactic placement of an IABP prior to noncardiac surgery.
随着主动脉内球囊反搏（IABP）的适应证不断演变，其一种潜在的新用途可能是在接受非心脏手术的高危心脏病患者术前预防性置入IABP。我们的目的是提出一种针对可能从IABP预防性置入中获益的高危心脏病患者的总体处理方法。
病例报告及决策分析。
构建一个决策模型，权衡危及生命的术后并发症风险与IABP置入导致的血管并发症风险，包括手术及可能的截肢风险。
文献回顾确定了10例在非心脏手术前接受IABP置入的患者。这些患者以及我们的3例病例确定了预防性IABP可能有用的患者群体。该群体包括因以下原因无法进行冠状动脉旁路移植术的冠心病（CAD）患者：（1）无法手术的CAD；（2）严重的并存疾病过程（如恶性肿瘤）；或（3）非心脏手术的紧急性质。决策分析表明，术前评估显示术后并发症风险极高的患者（Goldman分级IV级或Detsky分级III级且接受大手术）可能从非心脏手术前预防性置入IABP中获益最大。
