| Background And ObjectiveAt present,the aging of China's population is accentated,the number of patients with coronary atherosclerotic heart disease is increasing,and the number of patients with acute myocardial infarction is also increasing sharply.Emergency opening of occluded coronary arteries after acute myocardial infarction?AMI?can reduce the area of myocardial infarction,improve cardiac function,and enhance the survival rate of patients.However,complications after AMI,such as VSR,greatly increase the mortality rate of patients.VSR is a peauliar but very serious mechanical complication after AMI,the occurrence is 0.2%-0.5%.Ventricular blood dynamics changes due to the area of VSR,Patients with small ruptured area may not show clinical symptoms,and the ventricular blood flow of patients with large ruptured area rapidly changes from left to right can result fatality rate.At this time,the mortality of patients with drug therapy is high,and the most fundamental treatment is surgical treatment.Currently,the optimal time for surgical treatment has not been determined.According to literature reports[2],emergency surgery is generally not recommended,and surgical treatment is generally recommend 2-3 weeks after hemodynamic stability.At this time,necrotic and edema myocardium has formed"scar tissue",which is conducive to surgical treatment and increases the success rate of surgery.How to stabilize the patient's hemodynamics to 2-3 weeks after myocardial infarction has become a priority in preoperative treatment.In recent years,the application of cardiac auxiliary devices has provided surgical opportunities for patients with VSR after acute myocardial infarction.IABP is widely used in patients with acute and critical diseases due to its simple operation and fewer complications,such as VSR,cardiogenic shock and heart transplantation.Currently,femoral artery is usually selected as the puncture vessel to implant IABP.The auxiliary principle of IABP is the balloon situated between the subclavian artery and the renal artery,under the trigger of ecg or pressure signal,the air bag inflates in the diastolic period of the heart,increasing the diastolic pressure in the aorta,and increasing the diastolic pressure of the aorta by 30%-70%.Balloon in the systolic period of the heart quickly deflated,at this time the aortic pressure decreased 5%30%,making the left ventricular load reduced,cardiac output increased,the highest increased is 30%.The increase of cardiac output reduces the end diastolic pressure and volume of the left ventricle by 10%-15%and improves the left ventricular function[3].In addition,IABP increases both aortic diastolic blood pressure and coronary blood flow,increases myocardial oxygen supply,and after reducing the left ventricular end diastolic pressure,the left ventricular wall tension drops,which can reduce the myocardial oxygen consumption and improve the coronary blood flow under the endocardium.Existing literature has reported that the application of IABP in the perioperative period can improve immediate and long-term hemodynamics and reduce mortality[2].As one of the cardiac auxiliary devices,long-term application of IABP inevitably leads to related complications,such as blood oozing and mechanical thrombocytopenia,etc.,and how to prevent the occurrence of complications also affects the therapeutic effect.Combined with the patient's medical records,this paper explored the therapeutic effect of IABP in the treatment of patients with VSR after AMI,and provided clinical data and basis for the treatment of patients with later VSR.MethodsThe clinical data,diagnosis,treatment,results and prognosis of 33 patients with VSR after AMI from October 1,2015 to October 1,2018 in henan provincial people's hospital were retrospectively analyzed.A total of 33 subjects were studied,including 13 males?39%?and 20 females?61%?,with the youngest aged55 and the oldest aged 78?66.2 years on average?.Among them,14 cases were complicated with diabetes,17 cases with hypertension,and 8 cases with chronic renal insufficiency.All the patients with VSR had ST-segment elevation myocardial infarction?STEMI?,18 patients were treated with the MAQUET counter-pulsation machine,all of whom were treated with percutaneous femoral artery catheterization.Each patient was treated with the corresponding trigger mode according to the specific situation,and the application time ranged from 0.19 days to 25.9 days?an average of 14 days?.The changes of heart rate,blood pressure?systolic blood pressure,diastolic blood pressure?and central venous pressure in the IABP group before and after implantation at 2h,12h and 24h were analyzed and compared.The changes of cardiac and renal function,hospitalization time,hospitalization cost,CRRT time,ventilator time and30-day survival rate were compared between the IABP group and the non-iabp group.Complications happend during IABP application.Results1.The 30-day mortality of patients with interventricular septal perforation treated with IABP was significantly lower than that of patients without IABP,and the mean median survival time increased?30d vs.9d?.In this study,18 patients were assisted by IABP,and 10 patients?55%?were treated with IABP and maintained their vital signs until 2-3 weeks after myocardial infarction.Cardiogenic shock occurred in 8patients while waiting for surgery,7 patients died after ineffective rescue treatment,and 1 patient had a emergency treatment and died 2 days after surgery.Among the 15 patients with ventricular septal perforation without IABP,12 patients?80%?died due to hemodynamic disorders during hospitalization,and 3 patients?20%?did not die during the 30-day follow-up.2.Comparing two groups of patients can find that the application of IABP in patients with ventilator application time is lower than the patients who were not use IABP?12.56 h vs.22.33 h?,the application of CRRT time no difference between the two groups of patients?14.75 h vs.19.70 h?,the application of IABP in patients with length of hospital stay?22.06±11.27 d vs 10.33±6.46d?and cost?177650±11070 vs8120±5870?were higher than in patients who were not application of IABP.3.Implantation of IABP can improve cardiac and renal functions.After implantation of IABP for 24h,EF and SV increased and BNP decreased in patients in the IABP group.EF and SV were not significantly improved and BNP was increased in patients in the IABP group after 24h in hospital.At the same time,creatinine decreased in patients with IABP and increased in patients without IABP.4.IABP was helpful for the rapid improvement of hemodynamics of patients,and the heart rate,systolic blood pressure,diastolic blood pressure and central venous pressure of patients were improved 24hours after the application of IABP.5.Patients with IABP still had a relatively high incidence of complications.Among the patients with IABP,complications occurred in 7 cases?38%?,among which thrombocytopenia was the most common,with a total of 4 cases?22%?.Blood oozing occurred in 2 cases?11%?.Thrombosis occurred in 1 case?5%?.ConclusionPatients with ventricular septal perforation after acute myocardial infarction assisted by IABP can improve cardiac and renal functions,stabilize hemodynamics,provide preparation for a better operation time,improve the success rate of surgery,and prolong the survival time. |
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