主动脉内球囊反搏对再灌注治疗后急性前壁心肌梗死的治疗研究
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摘要
第一部分：应用Swan-Ganz导管评价再灌注成功的急性前壁ST段抬高心肌梗死患者早期应用主动脉内球囊反搏的临床研究
[目的]评价主动脉球囊反搏(intra-aortic balloon pump，IABP)对成功再灌注治疗后的急性前壁ST段抬高心肌梗死患者血流动力学指标、血浆脑钠素(brain natriueticpeptide，BNP)和左室舒张末期直径（left ventricular end-diastolic diameter，LVEDD）、左室射血分数（left ventricular ejection fraction，LVEF）值变化的意义，以及对其安全性的评价。
[方法]直接经皮冠状动脉介入治疗（primary percutaneous coronary intervention P-PCI）成功的急性前壁ST段抬高心肌梗死患者63例，发病至球囊开通时间3-12小时，均无心源性休克发生，在最优药物治疗基础上按是否应用IABP分成分为A组（IABP植入组，32例）、B组（对照组，31例）。swan-ganz导管测定患者人院后第1、5日平均肺动脉压力（mean pulmonary artery pressure，MPAP）、肺动脉嵌入压力（pulmonary capillarywedge pressure，PCWP）、心脏指数（cardiac index，CI）；免疫化学发光法测患者人院后第1、5、90日血浆BNP浓度，超声心动图测入院后第1、5、90日LVEDD、LVEF值。
[结果]
1.入院第一天两组年龄、性别、吸烟史、合并高血压、糖尿病、血脂代谢异常病史、发病至靶血管开通时间、血流动力学指标、BNP和LVEDD、LVEF值等的差异无统计学意义（P>0.05）。
2.入院后第5日A组MPAP、PCWP值均明显低于B组[(17.69±3.18)mmHg比(20.68±3.94)mmHg，P<0．05；(13.88±1.98)mmHg比(15.58±3.69)mmHg，P<0．05]；入院后第5日A组CI值明显高于B组[(3.19±0.40)min·m2比(2.95±0.37)min·m2，P<0.05]；
3.入院后第5日A组BNP值明显低于B组[(341.81±35.62)pg/ml比(373.52±58.76)pg/ml，P<0.05]；入院后第90日A组BNP值明显低于B组[(309.84±45.42)pg/ml比(343.71±65.38)pg/ml，P<0.05]
4.入院后第5日A组、B组LVEDD值和LVEF值无明显差别[(53.03±2.81)mm比(53.87±2.59)mm，P>0．05;(46.44%±3.99%)比(45.77%±3.52%)，P>0．05]；
5.入院后第90日， A组LVEDD值明显低于B组[(53.93±2.71)mm比(55.65±2.21)mm，P<0．05]；A、B组LVEF值无明显差别(49.69%±3.19%比48.19%±3.57%，P>0．05)。
6.应用IABP后的并发症：局部血肿9例（9/32，28.1%）、穿刺处感染1例（1/32，3.1%）、下肢缺血3例（3/32，9.4%），血小板计数下降2例（2/32，6.3%），以上均治疗后好转，球囊破裂1例（1/32，3.1%），无后遗症，对照组无以上并发症发生。
[结论]在最优药物治疗基础上，IABP能进一步改善不伴心源性休克、再灌注成功的急性前壁ST段抬高心肌梗死患者的血流动力学指标、降低BNP值、改善心功能指标和减少左室重构程度。
第二部分：主动脉球囊反搏对再灌注不良的急性前壁心肌梗死患者BNP和心功能的影响
[目的]评价主动脉球囊反搏(intra-aortic balloon pump，IABP)对再灌注不良的急性前壁ST段抬高心肌梗死患者治疗中的有效性和安全性及对血浆脑钠素(brain natriueticpeptide，BNP)和左室舒张末期直径（left ventricular end-diastolic diameter，LVEDD）、左室射血分数（left ventricular ejection fraction，LVEF）值变化的意义。
[方法]急性前壁ST段抬高心肌梗死患者40例，均是再灌注不良患者，在最优药物治
疗基础上按是否应用IABP分成分为A组（IABP植入组，20例），B组（对照组，20例）。免疫化学发光法测患者人院后第1、7、90日血浆BNP浓度，超声心动图测入院后第1、7日以及90日LVEDD、LVEF值。
[结果]
1.入院第一天两组年龄、性别、吸烟史、高血压、糖尿病、血脂代谢异常、发病至PCI术时间、BNP和LVEDD、LVEF值差异无统计学意义（P>0.05）。
2.入院后第7日A组BNP值明显低于B组（[691.95±152.50）pg/ml比（804.85±150.60）pg/ml，P<0．05]；
3.入院后第90日A组BNP值明显低于B组（[587.15±191.01）pg/ml比（722.00±174.44）pg/ml，P<0．05]
4.入院后第7日A组、B组LVEDD值和LVEF值无明显差别[(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.入院后第90日，A组LVEDD值明显低于B组[(55.45±2.48)mm比(58.35±2.58)mm，P<0．05]；A、B组LVEF值无明显差别（41.50%±3.46%比39.85%±2.83%，P>0．05)。
6.应用IABP后的并发症：局部血肿3例（3/20，15.0%）、穿刺处感染1例（1/20，5.0%）、下肢缺血1例（1/20，5.0%），血小板计数下降1例（1/20，5.0%），均治疗后好转，无后遗症。
[结论]在最优药物治疗基础上，IABP能进一步降低再灌注不良的急性前壁ST段抬高心肌梗死患者BNP值、改善心功能指标和减少左室重构程度。
第三部分：床边植入和导管室植入IABP的对比观察
[目的]对床边植入和导管室植入主动脉球囊反搏(intra-aortic balloon pump，IABP)在重症冠心病患者治疗中的可行性、有效性和安全性进行对比研究，旨在探讨床边植入IABP的价值。
[方法]回顾性分析重症冠心病需要植入IABP患者50例，在最优药物治疗基础上分成床边IABP植入组（A组，25例），导管室IABP植入组（B组，25例）。比较两种方法操作时程和治疗前后平均动脉压、心率、多巴胺的剂量、血浆脑钠素(brain natriueticpeptide，BNP)值及术后并发症。
[结果]
1.床边IABP植入组中有两例患者因导丝不能送入改为入导管室植入，入导管室后仍有一例患者和导管室IABP植入组一例患者因腹主动脉扭曲、钙化而植入失败。
2.两种方法操作时程差异有统计学意义[(26.70±7.61) mins比(21.84±4.20) mins，P<0．05]；
3.两组之间治疗前后平均动脉压无显著差异[治疗前(60.43±4.34) mmHg比(58.88±6.01) mmHg，P>0．05；治疗后(78.48±3.73) mmHg比(77.04±4.46) mmHg，P>0．05]；
4.治疗前后心率无显著差异[治疗前(120.69±13.29)次/min比(122.44±12.00)次/min，P>0．05；治疗后(106.00±13.23)次/min比(102.00±11.63)次/min，P>0．05]；
5.治疗前后多巴胺的剂量无显著差异[治疗前(14.74±4.10) ug/min·kg比(15.24±4.04)ug/min·kg，P>0．05；治疗后(8.35±2.66) ug/min·kg比(9.44±3.11) ug/min·kg，P>0．05]；
6.治疗前后BNP值无显著差异[治疗前(2259.26±406.54) pg/ml比(2409.72±352.27)pg/ml，P>0．05；治疗后(1009.78±216.18) pg/ml比(1026.16±238.61) pg/ml，P>0．05]。
7.两组间术后并发症无显著差异。[结论]床边IABP植入方法简便、疗效肯定、安全性好，可以作为IABP植入的常规方法。
PartⅠ The study of Intra-Aortic Balloon Counterpulsation evaluated by Swan-Ganzcatheter for the treatment of acute anterior myocardial infarctionafter successful reperfusion therapy
0bjectives
To 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.
Methods
Sixty-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．
Results
1. 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.
Conclusions
In 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 function
0bjectives
To 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.
Methods
Forty 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．
Results
1. 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 laboratory
0bjective
To 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.
Methods
Fifty 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.
Results
1. 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.
Conclusions
The way of implanting the IABP at the bedside in CCU was convenient, feasible, andsafe,so it might be selected as routine approach.
[目的]评价主动脉球囊反搏(intra-aortic balloon pump，IABP)对成功再灌注治疗后的急性前壁ST段抬高心肌梗死患者血流动力学指标、血浆脑钠素(brain natriueticpeptide，BNP)和左室舒张末期直径（left ventricular end-diastolic diameter，LVEDD）、左室射血分数（left ventricular ejection fraction，LVEF）值变化的意义，以及对其安全性的评价。
[方法]直接经皮冠状动脉介入治疗（primary percutaneous coronary intervention P-PCI）成功的急性前壁ST段抬高心肌梗死患者63例，发病至球囊开通时间3-12小时，均无心源性休克发生，在最优药物治疗基础上按是否应用IABP分成分为A组（IABP植入组，32例）、B组（对照组，31例）。swan-ganz导管测定患者人院后第1、5日平均肺动脉压力（mean pulmonary artery pressure，MPAP）、肺动脉嵌入压力（pulmonary capillarywedge pressure，PCWP）、心脏指数（cardiac index，CI）；免疫化学发光法测患者人院后第1、5、90日血浆BNP浓度，超声心动图测入院后第1、5、90日LVEDD、LVEF值。
[结果]
1.入院第一天两组年龄、性别、吸烟史、合并高血压、糖尿病、血脂代谢异常病史、发病至靶血管开通时间、血流动力学指标、BNP和LVEDD、LVEF值等的差异无统计学意义（P>0.05）。
2.入院后第5日A组MPAP、PCWP值均明显低于B组[(17.69±3.18)mmHg比(20.68±3.94)mmHg，P<0．05；(13.88±1.98)mmHg比(15.58±3.69)mmHg，P<0．05]；入院后第5日A组CI值明显高于B组[(3.19±0.40)min·m2比(2.95±0.37)min·m2，P<0.05]；
3.入院后第5日A组BNP值明显低于B组[(341.81±35.62)pg/ml比(373.52±58.76)pg/ml，P<0.05]；入院后第90日A组BNP值明显低于B组[(309.84±45.42)pg/ml比(343.71±65.38)pg/ml，P<0.05]
4.入院后第5日A组、B组LVEDD值和LVEF值无明显差别[(53.03±2.81)mm比(53.87±2.59)mm，P>0．05;(46.44%±3.99%)比(45.77%±3.52%)，P>0．05]；
5.入院后第90日， A组LVEDD值明显低于B组[(53.93±2.71)mm比(55.65±2.21)mm，P<0．05]；A、B组LVEF值无明显差别(49.69%±3.19%比48.19%±3.57%，P>0．05)。
6.应用IABP后的并发症：局部血肿9例（9/32，28.1%）、穿刺处感染1例（1/32，3.1%）、下肢缺血3例（3/32，9.4%），血小板计数下降2例（2/32，6.3%），以上均治疗后好转，球囊破裂1例（1/32，3.1%），无后遗症，对照组无以上并发症发生。
[结论]在最优药物治疗基础上，IABP能进一步改善不伴心源性休克、再灌注成功的急性前壁ST段抬高心肌梗死患者的血流动力学指标、降低BNP值、改善心功能指标和减少左室重构程度。
第二部分：主动脉球囊反搏对再灌注不良的急性前壁心肌梗死患者BNP和心功能的影响
[目的]评价主动脉球囊反搏(intra-aortic balloon pump，IABP)对再灌注不良的急性前壁ST段抬高心肌梗死患者治疗中的有效性和安全性及对血浆脑钠素(brain natriueticpeptide，BNP)和左室舒张末期直径（left ventricular end-diastolic diameter，LVEDD）、左室射血分数（left ventricular ejection fraction，LVEF）值变化的意义。
[方法]急性前壁ST段抬高心肌梗死患者40例，均是再灌注不良患者，在最优药物治
疗基础上按是否应用IABP分成分为A组（IABP植入组，20例），B组（对照组，20例）。免疫化学发光法测患者人院后第1、7、90日血浆BNP浓度，超声心动图测入院后第1、7日以及90日LVEDD、LVEF值。
[结果]
1.入院第一天两组年龄、性别、吸烟史、高血压、糖尿病、血脂代谢异常、发病至PCI术时间、BNP和LVEDD、LVEF值差异无统计学意义（P>0.05）。
2.入院后第7日A组BNP值明显低于B组（[691.95±152.50）pg/ml比（804.85±150.60）pg/ml，P<0．05]；
3.入院后第90日A组BNP值明显低于B组（[587.15±191.01）pg/ml比（722.00±174.44）pg/ml，P<0．05]
4.入院后第7日A组、B组LVEDD值和LVEF值无明显差别[(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.入院后第90日，A组LVEDD值明显低于B组[(55.45±2.48)mm比(58.35±2.58)mm，P<0．05]；A、B组LVEF值无明显差别（41.50%±3.46%比39.85%±2.83%，P>0．05)。
6.应用IABP后的并发症：局部血肿3例（3/20，15.0%）、穿刺处感染1例（1/20，5.0%）、下肢缺血1例（1/20，5.0%），血小板计数下降1例（1/20，5.0%），均治疗后好转，无后遗症。
[结论]在最优药物治疗基础上，IABP能进一步降低再灌注不良的急性前壁ST段抬高心肌梗死患者BNP值、改善心功能指标和减少左室重构程度。
第三部分：床边植入和导管室植入IABP的对比观察
[目的]对床边植入和导管室植入主动脉球囊反搏(intra-aortic balloon pump，IABP)在重症冠心病患者治疗中的可行性、有效性和安全性进行对比研究，旨在探讨床边植入IABP的价值。
[方法]回顾性分析重症冠心病需要植入IABP患者50例，在最优药物治疗基础上分成床边IABP植入组（A组，25例），导管室IABP植入组（B组，25例）。比较两种方法操作时程和治疗前后平均动脉压、心率、多巴胺的剂量、血浆脑钠素(brain natriueticpeptide，BNP)值及术后并发症。
[结果]
1.床边IABP植入组中有两例患者因导丝不能送入改为入导管室植入，入导管室后仍有一例患者和导管室IABP植入组一例患者因腹主动脉扭曲、钙化而植入失败。
2.两种方法操作时程差异有统计学意义[(26.70±7.61) mins比(21.84±4.20) mins，P<0．05]；
3.两组之间治疗前后平均动脉压无显著差异[治疗前(60.43±4.34) mmHg比(58.88±6.01) mmHg，P>0．05；治疗后(78.48±3.73) mmHg比(77.04±4.46) mmHg，P>0．05]；
4.治疗前后心率无显著差异[治疗前(120.69±13.29)次/min比(122.44±12.00)次/min，P>0．05；治疗后(106.00±13.23)次/min比(102.00±11.63)次/min，P>0．05]；
5.治疗前后多巴胺的剂量无显著差异[治疗前(14.74±4.10) ug/min·kg比(15.24±4.04)ug/min·kg，P>0．05；治疗后(8.35±2.66) ug/min·kg比(9.44±3.11) ug/min·kg，P>0．05]；
6.治疗前后BNP值无显著差异[治疗前(2259.26±406.54) pg/ml比(2409.72±352.27)pg/ml，P>0．05；治疗后(1009.78±216.18) pg/ml比(1026.16±238.61) pg/ml，P>0．05]。
7.两组间术后并发症无显著差异。[结论]床边IABP植入方法简便、疗效肯定、安全性好，可以作为IABP植入的常规方法。
PartⅠ The study of Intra-Aortic Balloon Counterpulsation evaluated by Swan-Ganzcatheter for the treatment of acute anterior myocardial infarctionafter successful reperfusion therapy
0bjectives
To 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.
Methods
Sixty-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．
Results
1. 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.
Conclusions
In 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 function
0bjectives
To 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.
Methods
Forty 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．
Results
1. 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 laboratory
0bjective
To 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.
Methods
Fifty 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.
Results
1. 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.
Conclusions
The way of implanting the IABP at the bedside in CCU was convenient, feasible, andsafe,so it might be selected as routine approach.
引文
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[1] Prondzinsky R,Lemm H,Swyter M,et a1.Intra-aortic balloon counterpulsation inpatients with acute myocardial infarction complicated by cardiogenic shock:theprospective,randomized IABP SHOCK Trial for attenuation of multiorgandysfunction syndrome[J].Crit Care Med,2010,38(1):152-160.
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[8]中华医学会心血管病学分会，中华心血管病杂志编辑委员会。急性ST段抬高型心肌梗死诊断和治疗指南[J]。中华心血管病杂志，2010，38（8），675-690。
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[10] Anna TK,Dzimierz MS Awomir D, et al. Normalisation of elevated ST segmentpredicts return of left ventricular systolic function and improved outcome in patientswith acute myocardial infarction, treated with primary coronary angioplasty[J].PolishHeart Journal,2004,60:6-10.
[11] Feldman LJ, Coste P, Furber A,et al. Incomplete resolution of ST segment elevation isa marker of transient microcirculatory dysfunction after stenting for acute myocardialinfarction.Circulation,2003,107:2684-2689.
[12] The TIMI Study Group. The Thrombolysis In Myocardial Infarction (TIMI) trial[J]. NEngl J Med,1985,31:932–936.
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