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摘要: 目的:探讨床旁紧急主动脉内球囊反搏术 (IABP) 的安全性、可行性及近期临床效果。方法:对37例患者尝试床旁紧急IABP置入术, 术后即拍床旁胸片, 以指导调整IABP导管位置。术后6个月内每月至少门诊复查1次。术后6个月行超声心动图复查。结果:31例患者 (83.8%) 成功实施床旁紧急IABP术, 平均年龄 (57.4±11.3) 岁, 男24例 (77.4%)。其中AMI合并心源性休克14例, AMI合并机械并发症3例, 急性心肌炎合并顽固性左心衰竭或 (和) 心源性休克3例, 合并恶性心律失常1例。失败6例均转送心导管室, 在X线直视下完成IABP置入术。失败主要原因为:导引导丝致股动脉内膜夹层1例, 导引导丝不能通过迂曲髂、股动脉、腹主动脉4例, 髂、股动脉狭窄致床旁导入IABP球囊导管遇阻1例。床旁平均置管时间 (15±10) min, 未发现与IABP置管相关的严重并发症, 如死亡、中风、胸、腹主动脉, 髂、股动脉等严重损伤等。住院期间并发症为:血小板减少4例 (12.9%), 穿刺侧下肢缺血、足背动脉搏动明显减弱2例 (6.4%), 穿刺部位局部出血、血肿2例 (6.4%), 上消化道出血1例 (3.2%)。结论:随着经验积累, 床旁紧急IABP术可行, 可省去搬运患者风险、节约宝贵抢救时间, 不失为一种有效应急救治手段, 但仍具潜在风险及伴发严重动脉损伤隐患, 需谨慎实施。Abstract: Objective: To test the feasibility, safety, and short-term clinical outcome of emergent intra-aortic balloon pump counterpulsation (IABP) insertion at the bedside.Method: We tried emergent IABP insertion at the bedside in 37patients.Chest X-Ray examination at the bedside was followed immediately to identify and adjust the position of IABP catheter.Clinical follow-up examinations were conducted on an out-patient basis, and follow-up cardiac ultrasound at 6-month was scheduled.Result: IABP was instituted successfully at the bedside in 31patients (83.8%), aged (57.4±11.3) years, of whom 24 (77.4%) were male.Reasons for failure were:dissection of the femoral artery in 1case, inability to negotiate femoral or abdominal artery tortuosity in 4cases, and inability to insert the balloon catheter in 1case.All these 6patients were transferred to the catheterization laboratory to complete the procedure.There're no procedure related major adverse cardiac and cerebrovascular events (MACCE) such as death, stroke, vessel perforation and other severe vessel damage.Minor complications were present in 9 procedures (29.0%):4with decrease of platelet count, 2with weakness of pedal artery pulse and/or lower limb ischemia, 2with access site bleeding and/or hematoma, and 1 with upper gastric tract bleeding.All of these resolved after balloon removal and required no further intervention.Conclusion: Emergent IABP insertion at the bedside is feasible and with acceptable clincal outcome with increasing operator experience.
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