The Clinical Value Of Early Applications Of IABP In Elective PCI To Patients With Massive Acute Myocardial Infarction(AMI)

Objective The research has choose that not suitable for admission toemergency revascularization large area type ST-segment elevation acute myocardialinfarction (acute myocardial infarction, AMI) patients as the research object, bylooking at the early application intra aortic balloon counter pulsation pump (Intraaortic balloon counter pulsation pump, IABP) blood dynamics, and cardiac function inpatients with coronary artery blood flow, the influence of major adverse cardiac eventsand (major adverse cardiac events, MACE) of occurring. Evaluation of line IABP earlyuse of patients with AMI elective PCI large clinical outcomes influence.Methods This study choice in November2009to June2011in The FirstAffiliated Hospital of Henan Science and Technology University admission heartmedicine lost thrombolysis and emergency treatment of large area AMI PCI timepatients were randomly divided into two groups: treatment group of52cases andcontrol48cases, two groups of general situation such as age, sex, nationality,occupation and clinical data such as blood pressure, cardiac function, blood sugar,blood fat and match. Two groups of acute myocardial infarction in standardizedtreatment, all in the final in hospital emergency coronary angiography, clear vascularinfarction related situation, the course of10to14days to review coronary angiographyand line PCI art. The treatment group in intervention room line after coronaryangiography implanted in the arrow aortic balloon counter pulsation. Inclusion criteria:age30-80years old; Accord with large area AMI diagnosis standard: at least have thefollowing article3of article2standard,(1) the ischemic chest pain clinical history;(2)the dynamic evolution electrocardiogram (ECG);(3) myocardial necrosis of theconcentration of the markers dynamic change; Come on12-48hours, not intentionalsource sex shock; No emergency PCI and thrombolytic indications; Do not fibrinolytictherapy. 1. According to coronary angiography after admission and ECG in interventionroom symptoms immediately by Judkins law do coronary angiography, cast as position,and the Digital Subtraction Angiography image processing system for coronary arterystenosis qualitative and quantitative analysis, at least one artery (the left anteriordescending, whirling teams, right coronary artery) acute occlusion, or time the block.2. Put all random IABP method was put into the large area of preventive IABPpatients with AMI, undergoing coronary angiography, instantly in intervention roomline IABP placement: strict aseptic operation to Seldinger method right or left punctureof femoral artery, send filar guide to aortic root, with expansion in advance inexpansion scabbard puncture, put into8F the artery scabbard, if patients quartileheight165cm,40ml chooses the Arrow IABP balloon catheter, or choose30ml IABPballoon catheter. In Digital Subtraction Angiography perspective along filar guideIABP balloon catheter to buy left subclavian artery underneath and renal arterybetween. Balloon catheter placement IABP counter pulsation after connection machineto ECG trigger mode1:1pacing (merger use in patients with atrial fibrillation pressuretrigger pattern) after stability according to heart rate,1or1:2pacing. In the bodyduring, termination shall not exceed30min beats. After implantation IABP to lowmolecular heparin40mg subcutaneous injection (2times a day), do not need toactivate blood coagulation time monitoring. IABP catheter center cavity with every1h5~10ml heparin saline wash (5000U heparin/500ml saline). Routine use ofantibiotics during IABP application and detailed records related complications.3. Observation and study the index IABP group and control group two timesbefore and after coronary angiography infarction related blood vessels TIMI flowgrading, compared between the two groups of four weeks complications and twogroups of cardiac function (echocardiographic determination EF value), two and a halfyears of MACE (major adverse cardiac events) happened.Results1. The two groups of patients, the basic characteristic and clinicalmedicine clinical baseline levels such as basic to match, the differences were notstatistically significant.2. The outcome was IABP treatment group and control group first coronaryangiography results: infarction related blood vessels, vascular infarction TIMI flowclassification and two groups of patients, cardiac function (40.8±5.2%vs41.4±4.8%p>0.05, the heart ultrasound EF) values match, comparable; IABP group twice before and after TIMI flow grading improve significantly, the heart also has obviously improved40.8±5.2%vs51.5±6.3%p <0.05, heart ultrasound EF value); The control group(41.4±4.8%vs41.5±6.6%p>0.05, the heart ultrasound EF value) indeximprovement is not obvious. Two groups within4weeks after complications (7.69%vs22.9%vs the control group, p <0.05) the experimental group was significantlylower than the control group. The major adverse cardiac events and a half years in3,was5.8%, and are serious heart failure, no acute or sub-acute thrombosis followingimplantation and death; The control group of major adverse cardiac events in7cases,incidence was14.6%, among which serious heart failure,4cases of acute or sub-acutethrombosis following implantation in2cases, death in1, two groups of comparisonsdifference was statistically significant (p <0.05).Conclusions Acute myocardial infarction with large area, early applicationintra aortic balloon (IABP) counter pulsation pump, can promote infarction, improvecardiac function in patients with coronary artery open, reduce the myocardialinfarction complications and heart adverse events.