Funk M, Gleason J, Foell D
Yale University School of Nursing, New Haven, CT 06536-0740.
Heart Lung. 1989 Nov;18(6):542-52.
In this prospective study we sought to establish the incidence and nature of lower limb ischemia in patients undergoing treatment with intraaortic balloon pump (IABP) counterpulsation and to determine risk factors for its development. The sample was composed of all 258 balloon catheter insertions or attempted insertions for IABP therapy in 249 patients during a 16-month period. Assessment of the lower limbs, hemodynamic status, and pertinent medications were recorded daily throughout the patient's hospitalization. Lower limb ischemia was present in 47%, with 14% having major ischemic complications. Multivariate logistic regression, which was based on variables found to be significant in univariate analysis, revealed that preexisting peripheral vascular disease, female sex, and diabetes mellitus were related to the development of the whole range of lower limb ischemic problems. Diabetes mellitus, cardiogenic shock, and a history of smoking were associated with major ischemia. Evaluation of risks and benefits before treatment with IABP counterpulsation and careful lower limb assessment before, during, and after counterpulsation may help reduce the complications associated with this lifesaving device.
在这项前瞻性研究中，我们试图确定接受主动脉内球囊反搏（IABP）治疗的患者下肢缺血的发生率和性质，并确定其发生的危险因素。样本包括在16个月期间对249例患者进行的258次IABP治疗球囊导管插入或尝试插入。在患者住院期间，每天记录下肢情况、血流动力学状态和相关用药。47%的患者出现下肢缺血，其中14%发生严重缺血并发症。基于单变量分析中发现的显著变量进行的多因素逻辑回归显示，既往存在外周血管疾病、女性和糖尿病与整个下肢缺血问题的发生有关。糖尿病、心源性休克和吸烟史与严重缺血相关。在进行IABP反搏治疗前评估风险和获益，并在反搏治疗前、治疗期间和治疗后仔细评估下肢情况，可能有助于减少与这种救生设备相关的并发症。
