Kahn J K, Rutherford B D, McConahay D R, Johnson W L, Giorgi L V, Hartzler G O
Cardiovascular Consultants, Inc., Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
J Am Coll Cardiol. 1990 Apr;15(5):1151-5. doi: 10.1016/0735-1097(90)90257-p.
Hemodynamic support may be desirable for selected patients with high risk characteristics undergoing elective coronary angioplasty. Twenty-eight high risk patients were studied with elective intraaortic balloon pump support over a recent 30 month period. Their mean age was 66 years; 10 patients were greater than or equal to 70 years old. Class III or IV angina was present in 23 patients (82%). The mean left ventricular ejection fraction was 24% (range 15% to 50%) and was less than 30% in 25 patients (89%). Three vessel disease was present in 26 patients (93%) and 7 patients had significant left main coronary artery disease. Ninety (96%) of 94 attempts to dilate stenoses were successful, including multivessel angioplasty in 21 patients (75%) and five left main coronary artery dilations. Decreases in systolic blood pressure to less than or equal to 70 mm Hg occurred in 11 patients (39%), but augmented diastolic pressure was greater than or equal to 90 mm Hg at all times. No deaths or myocardial infarctions occurred within 72 h of coronary angioplasty. Vascular complications requiring surgical repair occurred in three patients who had good operative results and no need for transfusions. Thus, intraaortic balloon pump support in patients with high risk features undergoing elective coronary angioplasty appears effective and relatively benign, although definite benefit cannot be proved without a randomized study. Newer techniques, such as in-laboratory cardiopulmonary bypass, must be compared with the results obtained with intraaortic balloon pump support alone.
对于接受择期冠状动脉血管成形术且具有高风险特征的特定患者，可能需要进行血流动力学支持。在最近30个月期间，对28例高风险患者进行了择期主动脉内球囊泵支持治疗的研究。他们的平均年龄为66岁；10例患者年龄大于或等于70岁。23例患者（82%）存在Ⅲ级或Ⅳ级心绞痛。平均左心室射血分数为24%（范围为15%至50%），25例患者（89%）的左心室射血分数小于30%。26例患者（93%）存在三支血管病变，7例患者有严重的左主干冠状动脉疾病。94次扩张狭窄的尝试中有90次（96%）成功，包括21例患者（75%）的多支血管血管成形术和5次左主干冠状动脉扩张。11例患者（39%）的收缩压降至小于或等于70 mmHg，但舒张压始终大于或等于90 mmHg。冠状动脉血管成形术72小时内未发生死亡或心肌梗死。3例患者出现需要手术修复的血管并发症，手术效果良好，无需输血。因此，对于接受择期冠状动脉血管成形术的高风险特征患者，主动脉内球囊泵支持似乎有效且相对安全，尽管未经随机研究无法证明其确切益处。必须将更新的技术，如实验室心肺转流术，与单独使用主动脉内球囊泵支持所获得的结果进行比较。
