Scholz K H, Ragab S, von zur Mühlen F, Schröder T, Werner G S, Mindel L, Kreuzer H
Department of Cardiology, University of Göttingen, Germany.
Eur Heart J. 1998 Mar;19(3):458-65. doi: 10.1053/euhj.1997.0802.
The aim of this study was to assess the risk of intra-aortic balloon counterpulsation and to identify clinical and procedural variables that would predict complications.
We analysed 381 consecutive patients who were treated between 1977 and 1995 at our catheterization laboratory and/or medical intensive care unit. The complications considered relevant were limb ischaemia requiring catheter removal, vascular injury, bleeding requiring transfusion, embolic events, and infection. In eight patients the balloon could not be inserted. The rate of complications for the remaining 373 patients was 12.9%. Between 1977 and 1980, surgical insertion was performed using a 12 French catheter with a complication rate of 30.4% (seven of 23 patients). Percutaneous implantation, performed after 1981, had an overall complication rate of 11.7% (41 of 350 patients). Using thinner catheters for percutaneous placement was associated with a reduction in the rate of complications, from 20.7% (17 of 82 patients) for 12 French catheters to 9.9% (10 of 101 patients) for 10.5 French catheters (P = 0.04), and 8.4% (14 of 167 patients) for 9.5 French catheters (P = 0.006). Multivariate logistic regression analysis identified duration of counterpulsation > 48 h (odds ratio 3.6), catheter size (odds ratio 3.4 for 12 French catheters), peripheral vascular disease (odds ratio 2.7), and shock (odds ratio 2.0) as independent risk factors for counterpulsation-associated complications. When considering 9.5 French catheters only (167 patients, all after 1992), the sole remaining independent risk factor was duration of counterpulsation > 48 h (odds ratio 3.8). Those patients with 9.5 French catheters in whom counterpulsation did not exceed 48 h had a low complication rate of 3.9%.
The rate of percutaneous intra-aortic balloon counterpulsation complications was thus significantly reduced by employing thinner catheters. It was at an acceptable level for 9.5 French catheters, where a long duration of counterpulsation emerged as the most significant factor associated with complications. Whether using even thinner catheters in combination with a sheathless implantation technique further minimizes the risk of counterpulsation remains to be seen.
本研究旨在评估主动脉内球囊反搏的风险，并确定可预测并发症的临床和操作变量。
我们分析了1977年至1995年间在我们的导管实验室和/或医疗重症监护病房接受治疗的381例连续患者。相关并发症包括需要拔除导管的肢体缺血、血管损伤、需要输血的出血、栓塞事件和感染。8例患者无法插入球囊。其余373例患者的并发症发生率为12.9%。1977年至1980年间，使用12F导管进行外科置入，并发症发生率为30.4%（23例患者中的7例）。1981年后进行的经皮植入，总体并发症发生率为11.7%（350例患者中的41例）。使用更细的导管进行经皮放置与并发症发生率降低相关，12F导管的并发症发生率从20.7%（82例患者中的17例）降至10.5F导管的9.9%（101例患者中的10例）（P = 0.04），9.5F导管的并发症发生率为8.4%（167例患者中的14例）（P = 0.006）。多因素逻辑回归分析确定反搏持续时间>48小时（比值比3.6）、导管尺寸（12F导管的比值比3.4）、外周血管疾病（比值比2.7）和休克（比值比2.0）为与反搏相关并发症的独立危险因素。仅考虑9.5F导管时（167例患者，均在1992年后），唯一剩余的独立危险因素是反搏持续时间>48小时（比值比3.8）。那些使用9.5F导管且反搏不超过48小时的患者并发症发生率低至3.9%。
因此，采用更细的导管可显著降低经皮主动脉内球囊反搏的并发症发生率。对于9.5F导管，该发生率处于可接受水平，其中反搏持续时间长是与并发症相关的最显著因素。使用更细的导管结合无鞘植入技术是否能进一步降低反搏风险还有待观察。
