Jiang Xuesong, Zhu Zhitao, Ye Ming, Yan Yan, Zheng Junbo, Dai Qingqing, Wen Lianghe, Wang Huaiquan, Lou Shaofei, Ma Hongmei, Ma Pingwei, Li Yunlong, Yang Tuoyun, Zuo Shu, Tian Ye
Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China.
Department of Cardiovascular Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China.
Exp Ther Med. 2017 May;13(5):1741-1748. doi: 10.3892/etm.2017.4177. Epub 2017 Mar 2.
Intra-aortic balloon pumps (IABP) have saved many patients with cardiogenic shock during the perioperative period of cardiac surgery. However, the ideal insertion timing is controversial. In the present study, we aimed to optimize the insertion timing, in order to increase the survival rate of the patients. A total of 197 patients with cardiogenic shock during the perioperative period of cardiac surgery and implemented IABP from January 2011 to October 2015 were selected for the study. Patients were divided into five groups on the basis of application timing of IABP: 0-60, 61-120, 121-180, 181-240 and >240 min. The 30-day mortality, application rate of continuous renal replacement therapy (CRRT), duration of mechanical ventilation, duration of hospital stay and hospitalization charges were analyzed in the above groups. The risk factors related to mortality and the occurrence of IABP complications were also analyzed. The mortality in the 0-60, 61-120, 121-180, 181-240 and >240 min groups were 42.17, 36.6, 77.3, 72.7 and 79.3%, respectively. Earlier IABP insertion resulted in less patients receiving CRRT from acute renal failure and less daily hospitalization charges. However, the IABP application timing had no effect on indexes such as hospitalization duration, duration of mechanical ventilation and total hospitalization charges. Multifactor logistic regression analysis indicated that the independent risk factors of death in patients with cardiogenic shock during cardiac surgery were related to IABP support timing and vasoactive-inotropic score (VIS) before balloon insertion. In the first 120 min of cardiogenic shock during the perioperative period of cardiac surgery, IABP application decreased 30-day mortality. Mortality was related with VIS score of patients, which can be used to predict the prognosis of patients with cardiogenic shock.
主动脉内球囊反搏泵（IABP）挽救了许多心脏手术围手术期心源性休克患者。然而，理想的置入时机仍存在争议。在本研究中，我们旨在优化置入时机，以提高患者生存率。选取2011年1月至2015年10月期间心脏手术围手术期发生心源性休克并实施IABP的197例患者进行研究。根据IABP应用时机将患者分为五组：0 - 60、61 - 120、121 - 180、181 - 240和>240分钟。分析上述各组的30天死亡率、持续肾脏替代治疗（CRRT）应用率、机械通气时间、住院时间和住院费用。还分析了与死亡率和IABP并发症发生相关的危险因素。0 - 60、61 - 120、121 - 180、181 - 240和>240分钟组的死亡率分别为42.17%、36.6%、77.3%、72.7%和79.3%。更早置入IABP可使因急性肾衰竭接受CRRT的患者减少，且每日住院费用降低。然而，IABP应用时机对住院时间、机械通气时间和总住院费用等指标无影响。多因素logistic回归分析表明，心脏手术期间心源性休克患者死亡的独立危险因素与IABP支持时机及球囊置入前血管活性药物评分（VIS）有关。在心脏手术围手术期心源性休克的最初120分钟内应用IABP可降低30天死亡率。死亡率与患者的VIS评分有关，VIS评分可用于预测心源性休克患者的预后。
