Craver J M, Kaplan J A, Jones E L, Kopchak J, Hatcher C R
Ann Surg. 1979 Jun;189(6):769-76. doi: 10.1097/00000658-197906000-00014.
Intra-aortic balloon pumping (IABP) to assist the failing circulation has become widely applied and accepted since its introduction in 1968. The elective, preoperative use of IABP for patients undergoing cardiac surgery has now become the controversy. The purposes of this report are to examine our experience with IABP and to determine its appropriate role in high-risk patients. IABP was utilized in 75 of 2333 (3.2%) adult cardiac surgical patients at Emory University Hospital from January 1976 through June 1978. IABP was required for refractory shock following cardiopulmonary bypass (CB) in 53 patients, for preoperative cardiogenic shock after acute myocardial infarction (CSMI) in nine and was electively placed prior to CB in 13. Sixty-two patients (81%) were able to separate from CB with IABP and pharmacologic support and were assisted 24-432 hours (median 64 hours). Fifty-five (73%) were weaned from IABP. Fifty (67%) are hospital survivors; late deaths have occurred in six patients (8%). Hemodynamic effect of IABP was demonstrated by comparison of pumping 1:1 to 1:8 mode in five balloon-dependent patients after CB. IABP was found to decrease systolic blood pressure, left ventricular filling pressure and peripheral resistance (p < .05). It increased diastolic and mean blood pressure, cardiac index and the endocardial viability ratio (p < .05). The post-CB use of IABP resulted in highest salvage when utilized to support failing hearts that required surgery despite recent preoperative infarction or when intraoperative ischemic injury had occurred. Poorest results were in patients with extensive chronic myocardial damage. Except in the case of preoperative cardiogenic shock, it was impossible to establish statistically reliable criteria for patients in whom elective preoperative insertion was found to be necessary. Careful surgical and anesthesia management with good monitoring can be used instead of preoperative IABP in the majority of (if not all) hemodynamically stable patients regardless of risk classification.
自1968年主动脉内球囊反搏（IABP）被引入用于辅助衰竭的循环以来，它已得到广泛应用和认可。心脏手术患者术前选择性使用IABP目前已成为争议焦点。本报告的目的是探讨我们使用IABP的经验，并确定其在高危患者中的适当作用。1976年1月至1978年6月期间，埃默里大学医院2333例成年心脏手术患者中有75例（3.2%）使用了IABP。53例患者在体外循环（CB）后出现难治性休克需要IABP，9例患者在急性心肌梗死后出现术前心源性休克（CSMI）需要IABP，13例患者在CB前选择性置入IABP。62例患者（81%）在IABP和药物支持下能够脱离CB，辅助时间为24 - 432小时（中位数64小时）。55例（73%）成功撤掉IABP。50例（67%）存活出院；6例患者（8%）出现晚期死亡。通过比较5例CB后依赖球囊的患者在1:1至1:8模式下的反搏情况，证实了IABP的血流动力学效应。发现IABP可降低收缩压、左心室充盈压和外周阻力（p < 0.05）。它可提高舒张压、平均血压、心脏指数和心内膜存活比率（p < 0.05）。CB后使用IABP在支持尽管近期术前梗死但仍需手术的衰竭心脏或术中发生缺血性损伤时，挽救成功率最高。结果最差的是广泛慢性心肌损伤患者。除术前心源性休克外，无法为发现有必要进行术前选择性置入IABP的患者建立统计学上可靠的标准。对于大多数（如果不是全部）血流动力学稳定的患者，无论风险分类如何，在仔细的手术和麻醉管理及良好监测下，可替代术前IABP。
