McNamara Michael W, Dixon Simon R, Goldstein James A
aSH Meijer Heart Center, Grand Rapids bDepartment of Cardiovascular Medicine, William Beaumont Hospital, Beaumont Health System, Royal Oak cOakland University William Beaumont Hospital School of Medicine, Rochester, Michigan, USA.
Coron Artery Dis. 2014 Nov;25(7):602-7. doi: 10.1097/MCA.0000000000000139.
This study investigated the immediate hemodynamic effects of intra-aortic balloon pump (IABP) support and clinical outcomes in patients with acute right ventricular infarction (RVI) complicated by hypotension.
IABP improves hypotension in patients with acute myocardial infarction and left ventricular shock, but the effects have not been well studied in acute RVI with predominant right ventricular shock.
We retrospectively analyzed hemodynamics and clinical outcomes in 32 patients with acute inferior ST elevation myocardial infarction complicated by RVI, in whom hypotension requiring IABP placement developed despite intact left ventricular ejection fraction.
Pre-IABP hypotension was present in all (100%) patients, and in every case IABP augmentation increased mean arterial pressure (55.9±7.4 to 76.8±14.7 mmHg, P<0.0001). Adverse clinical events included respiratory distress requiring intubation in 46.9%, cardiopulmonary resuscitation in 25%, episodes of ventricular tachycardia/fibrillation in 56.3%, and transvenous pacemaker placement in 56.3% of patients. There were six inhospital deaths (18.8%). Pre-IABP hemodynamics were similar in those patients who survived to discharge compared with those who died. However, in those patients who died, there was significantly lower augmentation of peak systolic blood pressure during IABP support compared with survivors (2.7±17 vs. 27±22 mmHg, P<0.015).
IABP support results in immediate hemodynamic improvement in patients with acute RVI complicated by shock. The majority of these shock patients survived and the magnitude of mean arterial pressure and peak systolic blood pressure augmentation may impart prognostic value.
本研究调查了主动脉内球囊反搏（IABP）支持对急性右心室梗死（RVI）合并低血压患者的即时血流动力学影响及临床结局。
IABP可改善急性心肌梗死和左心室休克患者的低血压，但在以右心室休克为主的急性RVI中，其效果尚未得到充分研究。
我们回顾性分析了32例急性下壁ST段抬高型心肌梗死合并RVI患者的血流动力学和临床结局，这些患者尽管左心室射血分数正常，但仍因低血压需要放置IABP。
所有（100%）患者在IABP置入前均存在低血压，且在每种情况下，IABP辅助均使平均动脉压升高（从55.9±7.4 mmHg升至76.8±14.7 mmHg，P<0.0001）。不良临床事件包括46.9%的患者需要插管的呼吸窘迫、25%的患者进行心肺复苏、56.3%的患者发生室性心动过速/心室颤动，以及56.3%的患者需要放置经静脉起搏器。有6例住院死亡（18.8%）。出院存活患者与死亡患者在IABP置入前的血流动力学相似。然而，在死亡患者中，IABP支持期间收缩压峰值的升高明显低于存活患者（2.7±17 vs. 27±22 mmHg，P<0.015）。
IABP支持可使急性RVI合并休克患者的血流动力学立即得到改善。这些休克患者大多数存活，平均动脉压和收缩压峰值升高的幅度可能具有预后价值。
