Pinkard J, Utley J R, Leyland S A, Morgan M, Johnson H
Division of Cardiac Surgery, Spartanburg Regional Medical Center, S.C.
J Thorac Cardiovasc Surg. 1993 Apr;105(4):721-8.
We compared the preoperative, operative, and postoperative characteristics of patients who required balloon pumps after coronary artery bypass graft procedures to determine the relative risks of femoral and aortic insertion. The balloon pump was inserted into the ascending aorta when femoral insertion was not possible because of occlusive disease or small femoral arteries. Femoral insertion was performed in 81 patients and aortic insertion in 42 patients. Patients with aortic insertion were more likely to be small and female (p < 0.05) and were more likely to have carotid bruits and a history of strokes or transient ischemic attacks (p < 0.05). Death was more common in the patients with aortic insertion (18/42, 42.9%) than in those with femoral insertion (19/81, 23.4%) (p < 0.05), as calculated with single regression analysis. Route of insertion was not a predictor of operative death, according to multiple regression analysis. Leg complications were more common in patients with femoral artery insertion (23/81, 28.4%) than in those with aortic insertion (0/42, 0.0%) (p < 0.05). No sternal complications occurred in either group. New neurologic abnormalities were not significantly different between the patients with aortic and femoral insertion. Aortic insertion is a safe alternative to femoral insertion of intraaortic balloon pumps and is associated with fewer leg complications in small or diseased iliac and femoral arteries. The greater mortality rate with aortic insertion is related to greater comorbidity rate in these patients.
我们比较了冠状动脉旁路移植术后需要使用球囊泵的患者的术前、术中及术后特征，以确定股动脉插入和主动脉插入的相对风险。当因闭塞性疾病或股动脉细小而无法进行股动脉插入时，将球囊泵插入升主动脉。81例患者进行了股动脉插入，42例患者进行了主动脉插入。进行主动脉插入的患者更可能身材矮小且为女性（p<0.05），更可能有颈动脉杂音以及中风或短暂性脑缺血发作史（p<0.05）。经单因素回归分析计算，主动脉插入患者的死亡率（18/42，42.9%）高于股动脉插入患者（19/81，23.4%）（p<0.05）。根据多因素回归分析，插入途径不是手术死亡的预测因素。股动脉插入患者的腿部并发症（23/81，28.4%）比主动脉插入患者（0/42，0.0%）更常见（p<0.05）。两组均未发生胸骨并发症。主动脉插入和股动脉插入患者的新发神经功能异常无显著差异。对于主动脉内球囊泵插入，主动脉插入是股动脉插入的一种安全替代方法，并且在髂动脉和股动脉细小或病变时腿部并发症较少。主动脉插入患者较高的死亡率与这些患者较高的合并症发生率有关。
