Christenson J T, Simonet F, Badel P, Schmuziger M
Cardiovascular Surgery Unit, Columbia Hôpital de la Tour, Meyrin-Geneva, Switzerland.
Thorac Cardiovasc Surg. 1997 Apr;45(2):60-4. doi: 10.1055/s-2007-1013688.
Poor left-ventricular function, hypertension, and left-ventricular hypertrophy in patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG) are associated with increased operative risks. Between June 1994 and March 1996, 33 patients undergoing CABG, were randomized into 2 groups. One group (IABP group, n = 19) received IABP treatment on average for 2 hours prior to CPB, the other group (control group, n = 14) had no preoperative IABP, Cardiac performance was measured pre- and postoperatively by Swan-Ganz catheter. Mean age was 65 years and 90% were men. All patients had a preoperative LVEF < or = 40% (mean 32.6 +/- 11.1%), 3-vessel disease, established hypertension (WHO criteria), and LV hypertrophy (ventricular mass > or = 136 g/m2 [men] or > or = 110 g/m2 [women]). Ischemia time was similar in both groups while CPB-time was shorter in the IABP group, p < 0.05. There were no hospital deaths in the IABP group, but 3 in the control group suffered postoperative low cardiac output. Nine patients (64%) in the control group required IABP support postoperatively, but only 20% of the patients in the IABP group had a shorter ICU stay, 2.4 +/- 0.9 vs. 3.4 +/- 1.1 days, p < 0.01. Cardiac index increased significantly in the IABP group prior to CPB and was higher compared to control, p < 0.001. Five min after CBP cardiac index was higher in the IABP group than in the control group, p = 0.013, and continued to increase thereafter, while no further improvement was observed in controls. Preoperative IABP treatment in hypertensive patients with CAD, low LVEF and LV hypertrophy who are undergoing CABG is beneficial. An improved cardiac performance pre- and postoperatively was associated with a lower rate of hospital mortality and less postoperative morbidity, as well as shorter ICU stay. The treatment is cost-beneficial.
接受冠状动脉旁路移植术（CABG）的冠心病（CAD）患者左心室功能不佳、高血压和左心室肥厚与手术风险增加相关。1994年6月至1996年3月期间，33例行CABG的患者被随机分为2组。一组（IABP组，n = 19）在体外循环（CPB）前平均接受IABP治疗2小时，另一组（对照组，n = 14）术前未接受IABP治疗。通过Swan - Ganz导管在术前和术后测量心脏功能。平均年龄为65岁，90%为男性。所有患者术前左心室射血分数（LVEF）≤40%（平均32.6±11.1%），三支血管病变，确诊高血压（WHO标准），以及左心室肥厚（心室质量≥136 g/m²[男性]或≥110 g/m²[女性]）。两组的缺血时间相似，而IABP组的CPB时间较短，p<0.05。IABP组无住院死亡病例，但对照组有3例术后出现低心排血量。对照组9例患者（64%）术后需要IABP支持，但IABP组只有20%的患者重症监护病房（ICU）住院时间较短，分别为2.4±0.9天和3.4±1.1天，p<0.01。IABP组在CPB前心脏指数显著增加，且高于对照组，p<0.001。CPB后5分钟，IABP组的心脏指数高于对照组，p = 0.013，此后持续升高，而对照组未观察到进一步改善。对于接受CABG的CAD、低LVEF和左心室肥厚的高血压患者，术前IABP治疗有益。术前和术后心脏功能的改善与较低的医院死亡率、较少的术后发病率以及较短的ICU住院时间相关。该治疗具有成本效益。
