Barnett M G, Swartz M T, Peterson G J, Naunheim K S, Pennington D G, Vaca K J, Fiore A C, McBride L R, Peigh P, Willman V L
Department of Surgery, St. Louis University Medical Center, MO 63110-0250.
J Vasc Surg. 1994 Jan;19(1):81-7; discussion 87-9. doi: 10.1016/s0741-5214(94)70123-7.
The purpose of this study was to assess the incidence of and predictors for vascular complications in patients who required perioperative intraaortic balloon pump (IABP) support.
Data from 580 patients collected with a retrospective review were statistically analyzed with 25 perioperative parameters, and significant variables were evaluated with multivariate analysis. These data were also statistically compared with data from a 1983 study from our institution.
Vascular complications occurred in 72 patients (12.4%). The three aortic perforations were fatal. Ipsilateral leg ischemia occurred in 69 patients. Of these, ischemia was resolved in 82% of patients by IABP removal (21), thrombectomy (21), vascular repair (13), fasciotomy (2), or without intervention (2). Six patients died with the intraaortic balloon in place. Four patients required amputation for ischemia, but all survived.
Vascular complications were not predictive of operative death (p = 0.26). Risk analyses with 25 perioperative parameters revealed that history of peripheral vascular disease, female sex, history of smoking, and postoperative insertion were independent predictors of vascular complications. However, most risk for vascular complications cannot be explained by these factors because of a low R2 value. Compared with the results of our 1983 study, the incidence of IABP-related complications has not changed, but the severity of complications has decreased significantly, and IABP-induced death has decreased significantly.
本研究旨在评估围手术期需要主动脉内球囊反搏（IABP）支持的患者血管并发症的发生率及预测因素。
对通过回顾性研究收集的580例患者的数据进行统计分析，分析25个围手术期参数，并通过多因素分析评估显著变量。这些数据还与我们机构1983年一项研究的数据进行了统计学比较。
72例患者（12.4%）发生血管并发症。3例主动脉穿孔是致命的。69例患者发生同侧下肢缺血。其中，82%的患者通过移除IABP（21例）、血栓切除术（21例）、血管修复（13例）、筋膜切开术（2例）或无需干预（2例）使缺血得到缓解。6例患者在主动脉内球囊在位时死亡。4例患者因缺血需要截肢，但均存活。
血管并发症不能预测手术死亡（p = 0.26）。对25个围手术期参数进行风险分析显示，外周血管疾病史、女性、吸烟史和术后置入是血管并发症的独立预测因素。然而，由于R2值较低，这些因素无法解释大多数血管并发症的风险。与我们1983年的研究结果相比，IABP相关并发症的发生率没有变化，但并发症的严重程度显著降低，IABP导致的死亡也显著减少。
