Torchiana D F, Hirsch G, Buckley M J, Hahn C, Allyn J W, Akins C W, Drake J F, Newell J B, Austen W G
Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
J Thorac Cardiovasc Surg. 1997 Apr;113(4):758-64; discussion 764-9. doi: 10.1016/S0022-5223(97)70235-6.
A total of 4756 cases of intraaortic balloon pump support have been recorded at the Massachusetts General Hospital since the first clinical insertion for cardiogenic shock in 1968. This report describes the patterns of intraaortic balloon use and associated outcomes over this time period.
A retrospective record review was conducted.
Balloon use has increased to more than 300 cases a year at present. The practice of balloon placement for control of ischemia (2453 cases, 11.9% mortality) has become more frequent, whereas support for hemodynamic decompensation (congestive heart failure, hypotension, cardiogenic shock) has been relatively constant (1760 cases, 38.2% mortality). Mean patient age has increased from 54 to 66 years, and mortality has fallen from 41% to 20%. Sixty-five percent (3097/4756) of the total patient population receiving balloon support underwent cardiac surgery. Placement before the operation (2038 patients) was associated with a lower mortality (13.6%) than intraoperative (771 patients, 35.7% mortality) or postoperative use (276 patients, 35.9% mortality). Independent predictors of death with balloon pump support were insertion in the operating room or intensive care unit, transthoracic insertion, age, procedure other than angioplasty or coronary artery bypass, and insertion for cardiogenic shock. Independent predictors of death with intraoperative balloon insertion were age, mitral valve replacement, prolonged cardiopulmonary bypass, urgent or emergency operation, preoperative renal dysfunction, complex ventricular ectopy, right ventricular failure, and emergency reinstitution of cardiopulmonary bypass.
Balloons are being used more frequently for control of ischemia in more patients who are elderly with lower mortality. An institutional bias toward preoperative use of the balloon pump appears to be associated with improved outcomes.
自1968年首次将主动脉内球囊泵用于心源性休克的临床治疗以来，麻省总医院共记录了4756例主动脉内球囊泵支持治疗的病例。本报告描述了这段时间内主动脉内球囊的使用模式及相关结果。
进行回顾性记录审查。
目前球囊使用量已增至每年300多例。为控制缺血而放置球囊的做法（2453例，死亡率11.9%）变得更为频繁，而对血流动力学失代偿（充血性心力衰竭、低血压、心源性休克）的支持相对稳定（1760例，死亡率38.2%）。患者平均年龄从54岁增至66岁，死亡率从41%降至20%。接受球囊支持的患者总数中有65%（3097/4756）接受了心脏手术。术前放置（2038例患者）的死亡率（13.6%）低于术中放置（771例患者，死亡率35.7%）或术后使用（276例患者，死亡率35.9%）。球囊泵支持治疗时死亡的独立预测因素包括在手术室或重症监护病房置入、经胸置入、年龄、非血管成形术或冠状动脉搭桥术的手术、因心源性休克置入。术中球囊置入时死亡的独立预测因素包括年龄、二尖瓣置换术、体外循环时间延长、急诊或紧急手术、术前肾功能不全、复杂室性早搏、右心室衰竭以及体外循环的紧急恢复。
球囊在更多老年患者中更频繁地用于控制缺血，且死亡率较低。机构对术前使用球囊泵的偏好似乎与改善结果相关。
