CAJ | 학술논문

目的：探讨术前主动置入和术中／术后被动置入主动脉内球囊反搏（intra-aortic balloon pump，IABP）对高危冠状动脉旁路移植术（coronary artery bypass graft，CABG）患者的应用价值。方法回顾性分析2010年3月～2012年12月我院高危 CABG 患者围手术期使用 IABP 90例资料，根据 IABP 置入的时机将患者分为 A、B 两组。A 组31例，术前预防性使用IABP；B 组59例，术中或术后应用 IABP。比较2组围手术期表现及随访期间主要心脑血管事件（major adverse cardiac or cerebrovascular events，MACCE）的差异。结果与 B 组相比，A 组 ICU 停留时间短[（70．2±50．5）h vs．（123．2±95．8） h，t ＝－3．436，P ＝0．010]；术后 IABP 支持时间（入 ICU 到 IABP 撤离）短[（21．8±13．9）h vs．（65．6±25．3）h，t ＝－10．576，P ＝0．000]；术后房颤少[0％（0／31）vs．23．7％（14／59），P ＝0．002]；术后急性肾损伤少[19．4％（6／31）vs．50．8％（30／59），χ2＝8．398，P ＝0．004]。随访（30．0±12．3）月，MACCE 两组比较无显著性差异。结论术前合理使用IABP，使 CABG 高危风险患者有良好的近期效果。
목적：탐토술전주동치입화술중／술후피동치입주동맥내구낭반박（intra-aortic balloon pump，IABP）대고위관상동맥방로이식술（coronary artery bypass graft，CABG）환자적응용개치。방법회고성분석2010년3월～2012년12월아원고위 CABG 환자위수술기사용 IABP 90례자료，근거 IABP 치입적시궤장환자분위 A、B 량조。A 조31례，술전예방성사용IABP；B 조59례，술중혹술후응용 IABP。비교2조위수술기표현급수방기간주요심뇌혈관사건（major adverse cardiac or cerebrovascular events，MACCE）적차이。결과여 B 조상비，A 조 ICU 정류시간단[（70．2±50．5）h vs．（123．2±95．8） h，t ＝－3．436，P ＝0．010]；술후 IABP 지지시간（입 ICU 도 IABP 철리）단[（21．8±13．9）h vs．（65．6±25．3）h，t ＝－10．576，P ＝0．000]；술후방전소[0％（0／31）vs．23．7％（14／59），P ＝0．002]；술후급성신손상소[19．4％（6／31）vs．50．8％（30／59），χ2＝8．398，P ＝0．004]。수방（30．0±12．3）월，MACCE 량조비교무현저성차이。결론술전합리사용IABP，사 CABG 고위풍험환자유량호적근기효과。
Objective To investigate the effects of intra-or post-operative preventative intra-aortic balloon pump (IABP) insertion in high risk coronary artery bypass patients. Methods From March 2010 to December 2012,90 consecutive patients undergoing coronary artery bypass graft (CABG)with IABP support were observed.The group A included 31 patients with preoperative IABP insertion,and the group B included 59 intra-or post-operative IABP insertion.Peri-operative clinical data and major adverse cardiac or cerebrovascular events(MACCE)during follow-ups were compared between the two groups. Results The ICU stay time was shorter significantly in the group A than in the group B [(70.2 ±50.5)h vs.(123.2 ±95.8)h,t =-3.436,P =0.010].The postoperative IABP support time in the group A was shorter than that in the group B [(21 .8 ±13.9 )h vs.(65.6 ±25.3 )h,t =-10.576,P =0.000].The postoperative atrial fibrillation rate was lower in the group A than in the group B [0% (0 /31 )vs. 23.7% (14 /59),P =0.002].The postoperative acute kidney injury (AKI)rate was significant lower in the group A than in the group B [19.4% (6 /31 )vs.50.8% (30 /59),χ2 =8.398,P =0.004].During follow-ups for (30.0 ±12.3)months,there were no differences in MACCE rate between the two groups. Conclusion Preventive preoperative use of IABP may help improve early outcomes in high risk CABG patients.