Chen Wei, Sheng Bo, Zhao Lei, Lu Fei-ping, Wang Suo-zhu, Liu Long, Gu Xu-yun, Zhang Jing-shu
Department of Intensive Care Unit, Capital Medical University, Beijing 100038, China. hanwa@yahoo. cn
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Jan;24(1):46-9.
To investigate the clinical efficacy and value of intra-aortic balloon pump (IABP) with vasoactive drugs for septic shock patients.
A method of single-centre registry was conducted. Data were collected from 78 consecutive septic shock patients in late stage in intensive care unit (ICU) of Beijing Shijitan Hospital diagnosed between July 2006 and October 2010. With the consent of family members of the patients, they were divided into two groups: group A, in whom only vasoactive drugs were used (dopamine + norepinephrine treatment, n = 39), and group B, in whom vasoactive drugs were used combined with IABP (dopamine + norepinephrine + IABP therapy, n = 39). Before and after treatment of two groups, hemodynamic and tissue perfusion monitoring were executed. At the same time, the shock recovery time, the doses of vasoactive drugs, length of ICU stay, and mortality within 28 days were observed.
There was no significant difference in all above parameters between two groups. After treatment, heart rate, blood pressure and heart function parameters were significantly improved compared with those before treatment. In group B, mean arterial pressure (MAP, mm Hg,1 mm Hg = 0.133 kPa) 24 hours and 72 hours after IABP, cardiac index [CI, L×min(-1)× m(-2)] after 48 hours of IABP, and in 2 hours after termination of IABP, dopamine dosage [μg×kg(-1)×min(-1)] in 24, 48, 72 hours after IABP and 2 hours after termination were significantly improved than those in group A (MAP: 53.0 ± 6.3 vs. 52.1 ± 6.2, 65.6 ± 4.3 vs. 65.0 ± 2.1; CI: 3.40 ± 0.20 vs. 3.30 ± 0.50, 3.60 ± 0.30 vs. 3.60 ± 0.30; dopamine dosage: 17.5 ± 1.2 vs. 17.6 ± 1.3, 10.2 ± 1.3 vs. 12.8 ± 1.6, 5.8 ± 1.5 vs. 6.8 ± 1.7, 3.0 ± 0.7 vs. 4.1 ± 1.3, P < 0.05 or P < 0.01). Compared with group A, shock recovery time (days) of group B was significantly shorter (10.4 ± 2.2 vs. 14.1 ± 3.4, P < 0.01) than that of group A; mortality within 28 days was significantly lower (34.1% vs. 45.6%, P < 0.01) in group B; length of ICU stay of two groups showed no significant difference between two groups.
IABP in patients with septic shock significantly improved hemodynamics, increased coronary and systemic tissue perfusion, reduced cardiac afterload, elevated CI, reduced doses of vasoactive drugs, shortened length of ICU stay, improved prognosis, and lowered the mortality rate. IABP had important clinical value, and could be recommended as an additional treatment option in patients with septic shock in whom the effect of drug was poor.
探讨主动脉内球囊反搏（IABP）联合血管活性药物治疗感染性休克患者的临床疗效及价值。
采用单中心登记研究方法。收集2006年7月至2010年10月在北京世纪坛医院重症监护病房（ICU）确诊的78例连续性晚期感染性休克患者的数据。经患者家属同意，将患者分为两组：A组，仅使用血管活性药物（多巴胺+去甲肾上腺素治疗，n = 39）；B组，血管活性药物联合IABP（多巴胺+去甲肾上腺素+IABP治疗，n = 39）。两组治疗前后均进行血流动力学和组织灌注监测。同时，观察休克恢复时间、血管活性药物剂量、ICU住院时间及28天内死亡率。
两组上述所有参数比较差异均无统计学意义。治疗后，两组心率、血压及心功能参数均较治疗前明显改善。B组IABP术后24小时和72小时的平均动脉压（MAP，mmHg，1 mmHg = 0.133 kPa）、IABP术后48小时的心脏指数[CI，L×min-1×m-2]及IABP停用后2小时的MAP、IABP术后24、48、72小时及停用后2小时的多巴胺剂量[μg×kg-1×min-1]均明显优于A组（MAP：53.0±6.3 vs. 52.1±6.2，65.6±4.3 vs. 65.0±2.1；CI：3.40±0.20 vs. 3.30±0.50，3.60±0.30 vs. 3.60±0.30；多巴胺剂量：17.5±1.2 vs. 17.6±1.3，10.2±1.3 vs. 12.8±1.6，5.8±1.5 vs. 6.8±1.7，3.0±0.7 vs. 4.1±1.3，P < 0.05或P < 0.01）。与A组比较，B组休克恢复时间（天）明显缩短（10.4±2.2 vs. 14.1±3.4，P < 0.01）；B组28天内死亡率明显降低（34.1% vs. 45.6%，P < 0.01）；两组ICU住院时间比较差异无统计学意义。
IABP治疗感染性休克患者可显著改善血流动力学，增加冠状动脉及全身组织灌注，降低心脏后负荷，提高CI，减少血管活性药物剂量，缩短ICU住院时间，改善预后，降低死亡率。IABP具有重要的临床价值，可作为药物治疗效果不佳的感染性休克患者的附加治疗选择推荐使用。
