| PartⅠ The study of Intra-Aortic Balloon Counterpulsation evaluated by Swan-Ganzcatheter for the treatment of acute anterior myocardial infarctionafter successful reperfusion therapy0bjectivesTo evaluate the influence of intra-aortic balloon pump(IABP) in patients with acuteST-segment elevation myocardial infarction after successful reperfusion therapy on the thevalues of hemodynamics index,concentration of serum brain natriuretic peptide (BNP),echocardiogram and safety.MethodsSixty-three patients with acute anterior wall ST-segment elevation myocardialinfarction after successful primary percutaneous coronary intervention therapy weredivided into IABP group (A：32cases)and control group(B：31cases) based upon theoptimal medication,Respectively.The time from discomfort to ballon was3hours to12hours and no one was cardiogenic shock.The values of mean pulmonary arterypressure(MPAP), pulmonary capillary wedge pressure(PCWP) and cardiac index (CI) weremeasured by Swan-Ganz catheter at1,5days after admission.The plasma concentration ofBNP was measured by chemiluminescence immunoassay;Left ventricular end-diastolicdiameter(LVEDD) and left ventricular ejection fraction(LVEF)were measured byechocardiography at1,5,90days after admission． Results1. There were no statistical difference between two groups on day1of age,gender,smoking history, hypertension, diabetes, blood lipid metabolic abnormalities, time ofdiscomfort to target vessel patency, the values of hemodynamics index, BNP, LVEDDand LVEF（P>0.05）.2. On day5, the values of MPAP and PCWP in group A were lower[(17.69±3.18)mmHgvs (20.68±3.94)mmHg，P<0.05；(13.88±1.98)mmHg vs (15.58±3.69)mmHg，P<0.05]，the values of CI in group A were greater[(3.19±0.40)min·m2vs (2.95±0.37)min·m2，P<0.05]；3. On day5and90, the values of concentration of BNP in group A were less than those ingroup B[(341.81±35.62)pg/ml vs (373.52±58.76)pg/ml，P<0．05；(309.84±45.42)pg/mlvs (343.71±65.38)pg/ml，P<0．05].4. On day5, the values of LVEDD and LVEF in group A and in groupB were no statisticaldifference [(53.03±2.81)mm vs (53.87±2.59)mm， P>0.05;(46.44%±3.99%) vs(45.77%±3.52%)，P>0.05];5. On day90, the values of LVEDD in group A were lower[(53.93±2.71)mm vs(55.65±2.21)mm， P<0.05]; the values of LVEF were no statisticaldifference(49.69%±3.19%vs48.19%±3.57%，P>0.05).6. Complications after IABP:Nine local hematomas（9/32，28.1%）,one case of infection（1/32，3.1%）,three caseof lower limb ischemia（3/32，9.4%）,two case of decreased platelet count（2/32，6.3%）,one case of Balloon burst（1/32，3.1%）,All of no sequela.ConclusionsIn the patients with acute anterior wall ST-elevation myocardial infarction aftersuccessful reperfusion therapy without cardiogenic shock, based upon the optimalmedication,IABP is an effective method to improve the values of hemodynamics index andechocardiogram,drop the values of plasma BNP and reduce the degree of left ventricularremodeling. Part ⅡE ffect of intra-aortic ballon counterpulsation in patients withacute anterior myocardial infarction after unsuccessful reperfusiontherapy on serum brain natriuretic peptide and cardiac function0bjectivesTo evaluate the effective and the safety of intra-aortic balloon pump in patients withacute anterior myocardial infarction after unsuccessful reperfusion therapy on theconcentration of serum brain natriuretic peptide and the values of left ventricularend-diastolic diameter and left ventricular ejection fraction.MethodsForty patients with acute anterior myocardial infarction after unsuccessful reperfusiontherapy were divided into IABP group (A：20cases)and control group(B：20cases) basedupon the optimal medication,respectively．The plasma concentration of BNP was measuredby chemiluminescence immunoassay at1,7,90days after admission and left ventricularend-diastolic diameter(LVEDD) and left ventricular ejection fraction(LVEF)were measuredby echocardiography at1,7,90days after admission．Results1. There were no statistical difference between two groups on day1of age,gender,smoking history, hypertension, diabetes, blood lipid metabolic abnormalities, time ofdiscomfort to PCI, the values of concentration of BNP, LVEDD and LVEF.2. On the7th day of admission, the values of concentration of BNP in group A were lessthan those in group B[（691.95±152.50）pg/ml vs（804.85±150.60）pg/ml，P<0.05].3. On the90th day of admission, the values of concentration of BNP in group A were lessthan those in group B[（587.15±191.01）pg/ml vs（722.00±174.44）pg/ml，P<0.05]. 4. On the7th day of admission, the values of LVEDD and LVEF in group A and ingroupB were no statistical difference [(49.95±2.31)mm比(51.05±2.93)mm，P>0.05;(44.40%±2.01%)比(42.95%±2.84%)，P>0.05];5. On the90th day of admission, the values of LVEDD in group A were less than those ingroup B[(55.45±2.48)mm比(58.35±2.58)mm，P<0.05]; the values of LVEF in group Aand in groupB were no statistical differenc（e41.50%±3.46%比39.85%±2.83%，P>0.05)6. Complications after IABP:Three local hematomas（3/20，15.0%）,one case of infection（1/20，5.0%）, one caseof lower limb ischemia（1/20，5.0%）,one case of decreased platelet count（1/20，5.0%）,All of no sequela.Conclusions In the patients with acute anterior myocardial infarction after unsuccessfulreperfusion therapy, based upon the optimal medication,IABP is an effective method todrop plasma BNP level, improve the values of the cardiac function and reduce the degreeof left ventricular remodeling.． Part ⅢA comparative study on implanting the IABP at the bedside vs inthe catheterization laboratory0bjectiveTo compare the feasibility, effectiveness and safety of implanting theIABP(intra-aortic balloon pump) at the bedside in CCU(Coronary Care Unit)with in thecatheterization laboratory for evaluating the value of the former.MethodsFifty patients with serious coronary heart disease were retrospectively analyzed anddivided into implanting the IABP at the bedside in CCU (A：25cases)and implanting theIABP in the catheterization laboratory (B：25cases) based upon the optimalmedication．The operation duration, mean arterial pressure, heart rate, the dose of dopamine, the value of BNP(brain natriuetic peptide) and the incidences of complicationswere compared respectively.Results1. Two cases in group A were crossed over in group B because the guide wire failed toenter into,likewise, two cases in each of groupA and B failed to be implanted becausetheir abdominal aortas were tortuose and calcific.2. There was statistical difference regarding the operation duration among twogroups[(26.70±7.61) mins比(21.84±4.20) mins,P<0.05];3. Before and after IABP implanting,there was no statistical difference regarding theMAP(mean artery pressure)[(60.43±4.34) mmHg vs(58.88±6.01) mmHg，P>0.05；(78.48±3.73) mmHg vs(77.04±4.46) mmHg，P>0.05];4. there was no statistical difference regarding the heart rate[(120.69±13.29) beats perminute vs(122.44±12.00) beats per minute，P>0.05；(106.00±13.23) beats per minutevs(102.00±11.63) beats per minute，P>0.05];5. there was no statistical difference regarding the dose of the dopamine[(14.74±4.10)ug/min·kg vs(15.24±4.04) ug/min·kg，P>0.05；(8.35±2.66) ug/min·kg vs (9.44±3.11)ug/min·kg，P>0.05];6. there was no statistical difference regarding the value of the BNP[(2259.26±406.54)pg/ml vs (2409.72±352.27) pg/ml， P>0.05；(1009.78±216.18) pg/ml vs(1026.16±238.61) pg/ml，P>0.05];7. there was no statistical difference regarding the incidences of complications.ConclusionsThe way of implanting the IABP at the bedside in CCU was convenient, feasible, andsafe,so it might be selected as routine approach. |
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