Encouraging survival rates in patients with acute myocardial infarction treated with an intra-aortic balloon pump

Objective

To evaluate a 30-day and long-term outcome of patients with acute myocardial infarction (AMI) treated with intra-aortic balloon pump (IABP) counterpulsation and to identify predictors of a 30-day and long-term all-cause mortality.

Methods

Retrospective cohort study of 437 consecutive AMI patients treated with IABP between January 1990 and June 2004. A Cox proportional hazards model was used to identify predictors of a 30-day and long-term all-cause mortality.

Results

Mean age of the study population was 61 ± 11 years, 80% of the patients were male, and 68% had cardiogenic shock. Survival until IABP removal after successful haemodynamic stabilisation was 78% (n = 341). Cumulative 30-day survival was 68%. Median follow-up was 2.9 years (range, 6 months to 15 years). In patients who survived until IABP removal, cumulative 1-, 5-, and 10-year survival was 75%, 61%, and 39%, respectively. Independent predictors of higher long-term mortality were prior cerebrovascular accident (hazard ratio (HR), 1.8; 95% confidence interval (CI), 1.0–3.4), need for antiarrhythmic drugs (HR, 2.3; 95% CI, 1.5–3.3), and need for renal replacement therapy (HR, 2.3; 95% CI, 1.2–4.3). Independent predictors of lower long-term mortality were primary percutaneous coronary intervention (PCI; HR, 0.6; 95% CI, 0.4–1.0), failed thrombolysis with rescue PCI (HR, 0.5; 95% CI, 0.3–0.9), and coronary artery bypass grafting (HR, 0.3; 95% CI, 0.1–0.5).

Conclusions

Despite high in-hospital mortality in patients with AMI treated with IABP, a favourable number of patients survived in the long-term. These results underscore the value of aggressive haemodynamic support of patients throughout the acute phase of AMI.     

主动脉内球囊反搏在急性心肌梗死急诊PCI术后无血流现象中的应用

目的：探讨主动脉内球囊反搏（IABP）在急性心肌梗死（AMI）急诊冠脉介入术（PCI）后无复流现象（NR）中的治疗作用。方法：分析自2006年1月至2009年12月因急性心肌梗死（AMI）行PCI术后无血流患者22例资料,采用随机分组方法将其中12例运用IABP治疗,其余10例为对照组,观察术后10天内心肌损伤标志物、脑钠肽（BNP）恢复情况,心肌损伤标志物包括肌红蛋白（MYO）,肌酸激酶同工酶（CK-MB）,肌钙蛋白（ICTNI）;治疗10天后应用彩色超声心动图测量患者左房内径、左室内径、左室射血分数（LVEF）;并随访3个月、6个月左房内径、左室内径、左室射血分数（LVEF）变化情况。结果：IABP治疗组患者心肌损伤标志物指标时间-浓度曲线显示指标下降明显快于对照组,与对照组相比差别有统计学意义（P〈0.05）;IABP组BNP峰值较对照组提前,IABP治疗组BNP指标时间-浓度曲线显示指标下降明显快于对照组,与对照组相比差别无统计学意义（P〉0.05）;超声心动图测量两组患者10天、3个月及6个月时左房内径、左室内径差别及LVEF差别有统计学意义（P〈0.05）。结论：IABP能够加速降低AMI急诊PCI术后发生无复流现象患者升高心肌损伤标志物的水平;使BNP峰值提前并改善10天、3个月及6个月时左房内径、左室内径及EF值对心功能具有一定的改善作用。     

A numerical analysis of the aortic blood flow pattern during pulsed cardiopulmonary bypass

In the modern era, stroke remains a main cause of morbidity after cardiac surgery despite continuing improvements in the cardiopulmonary bypass (CPB) techniques. The aim of the current work was to numerically investigate the blood flow in aorta and epiaortic vessels during standard and pulsed CPB, obtained with the intra-aortic balloon pump (IABP). A multi-scale model, realized coupling a 3D computational fluid dynamics study with a 0D model, was developed and validated with in vivo data. The presence of IABP improved the flow pattern directed towards the epiaortic vessels with a mean flow increase of 6.3% and reduced flow vorticity.     

乳酸依沙吖啶联合子宫颈扩张单球囊对瘢痕子宫中期妊娠引产的应用效果

目的:研究乳酸依沙吖啶联合子宫颈扩张单球囊对瘢痕子宫中期妊娠引产的应用效果。方法:选择2014年4月~2016年12月在我院进行诊治的由于社会因素或者医学因素自愿要求终止妊娠并无任何引产禁忌证的110例健康中期妊娠(孕周14~27周)孕妇为研究对象,随机分为观察组与对照组,每组各55例。对照组采用常规方案进行引产,即口服米非司酮150 mg,并在B超引导下经腹壁行羊膜腔内注射100 mg乳酸依沙吖啶;观察组采用乳酸依沙吖啶联合子宫颈扩张单球囊进行引产。比较两组孕妇的引产成功率、产程时间、宫缩发动时间、胎儿娩出时间、产后2 h出血量、住院时间、引产并发症的发生情况以及多次剖宫产患者的引产成功率。结果:观察组孕妇的引产成功率为96.36%(53/55),明显高于对照组[83.64%(46/55)](P0.05),且观察组的产程时间、宫缩发动时间、产后2 h出血量以及住院时间均明显低于对照组(P0.05)。对照组多次剖宫产孕妇引产成功率为33.33%(2/6),观察组多次剖宫产孕妇引产成功率为100.00%(7/7),观察组明显高于对照组(P0.05)。对照组发生宫颈裂伤1例,会阴裂伤1例,两组孕妇均未出现羊水栓塞、子宫破裂以及感染等并发症。结论:乳酸依沙吖啶联合子宫颈扩张单球囊用于瘢痕子宫中期妊娠引产的应用效果明显优于口服米非司酮并在B超引导下经腹壁行羊膜腔内注射乳酸依沙吖啶,且安全性高。     

IABP支持下急诊PCI治疗急性心肌梗死并心源性休克的疗效观察

目的:探讨主动脉内球囊反搏(IABP)支持下急诊经皮冠状动脉介入(PCI)治疗急性心肌梗死(AMI)并心源性休克(CS)的临床疗效。方法:选取急诊PCI治疗的AMI并CS的患者47例,24例接受IABP支持下急诊PCI治疗的患者为治疗组,23例直接急诊PCI治疗的患者为对照组。治疗一周后,检测两组患者平均动脉压(MAP)、尿量、心率、肺动脉楔压(PCWP)、心脏指数(CI)、左室射血分数(LVEF)、及N末端血浆B型尿钠肽前体(NT-pro BNP)指标的变化,多巴胺、速尿和硝酸酯类用量的比较及死亡率比较。结果:治疗前两组各项观察指标差异无统计学意义(P0.05);治疗后两组各项观察指标与治疗前比较,差异均有统计学意义(P0.05);治疗后两组各观察指标差值比较,差异有统计学意义(P0.05);治疗组多巴胺、速尿用量少于对照组,差异有统计学意义(P0.05);治疗组硝酸酯类用量少于对照组,但差异无统计学意义(P0.05);治疗后两组死亡率比较,差异有统计学意义(P0.05)。结论:急性心肌梗死并心源性休克患者在IABP支持下行急诊PCI,可明显改善患者的冠状动脉血流,改善心肌的血供,改善心功能,降低病死率。     

Antioxidant metabolism in Xenopus laevis embryos is affected by stratospheric balloon flight

To test the effects of low levels of radiation from space on living organisms, we flew Xenopus laevis embryos at different stages of development on a stratospheric balloon (BI.R.BA mission). After recovery, different parameters were analyzed to assess the effects of flight, with particular regard to oxidative stress damage. Because of failed temperature control during flight, the flight shielded embryos (FC) could not be used for biochemical or morphological comparisons. In contrast, the incubation conditions (i.e. temperature, containers, volumes) for the flight embryos (F) were parallel to those for the ground controls. Mortality data show that younger embryos (16 h) flown on the balloon (F) are more sensitive to radiation exposure than older ones (40 h and 6 days). Exposure during flight lowered the antioxidant potential in all embryos, particularly older ones. These preliminary data demonstrate that flight on a stratospheric balloon might affect antioxidant metabolism, though it is not yet possible to correlate these results with low radiation exposure during flight.     

单球囊双侧扩张后凸成形术治疗不同程度骨质疏松性椎体压缩骨折的疗效

目的:观察单球囊双侧交替扩张后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效。方法:选择我院2014年7月-2015年5月收治的老年骨质疏松性椎体压缩骨折患者60例,按照椎体塌陷程度分为重度骨折组和轻度骨折组,每组各30例。两组患者均接受单球囊双侧交替扩张后凸成形术治疗,观察治疗效果和椎体变化等。结果:与轻度骨折组比较,重度骨折组手术时间长、骨水泥注射量少,且椎体前缘高度恢复率、椎体中部高度恢复率、Cobb角矫正度高(P0.05)。治疗后,两组患者VAS评分均优于治疗前(P0.05),但两组间差异无统计学意义(P0.05)。与治疗前比较,两组治疗后椎体前缘高度、椎体中部高度、Cobb角均有所改善(P0.05),轻度骨折组的椎体前缘高度、椎体中部高度明显大于重度骨折组(P0.05),但两组Cobb角比较,差异无统计学意义(P0.05)。结论:单球囊双侧交替扩张后凸成形术治疗老年骨质疏松性椎体压缩骨折具有较好的临床疗效,可以明显纠正椎体塌陷和Cobb角度。     

主动脉内球囊反搏术对行经皮冠状动脉介入术AMI合并CS患者的影响及术后院内死亡的危险因素分析

摘要 目的：分析主动脉内球囊反搏术（IABP）对行经皮冠状动脉介入术（PCI）急性心肌梗死（AMI）合并心源性休克（CS）患者的影响及术后院内死亡的危险因素。方法：选取2020年6月-2022年5月我院收治的105例AMI合并CS患者,将直接行PCI治疗患者设为对照组（n=59例）,行IABP辅助支持下PCI治疗患者设为研究组（n=46例）。比较两组术后心脏指标[左室射血分数（LVEF）、左室舒张末期内径（LVEDD）和左室收缩末期内径（LVESD）]、心肌酶谱指标[心肌肌钙蛋白T与肌钙蛋白I、肌酸激酶同工酶（CK-MB）]、术后主要心血管不良事件。根据患者出院时是否存活分为存活组（n=74）与死亡组（n=31）,比较两组临床资料,采用多因素Logistic回归模型分析患者院内死亡的危险因素。结果：术后两组LVEF较术前提高,LVEDD、LVESD降低,且研究组LVEF高于对照组,LVEDD、LVESD低于对照组（P＜0.05）。术后两组心肌酶谱指标较术前显著下降,且研究组肌钙蛋白I、肌钙蛋白T、CK-MB水平低于对照组（P＜0.05）。术后对照组发生5例再发心肌梗死、7例急性血栓形成,研究组分别为2例、3例（P＞0.05）;对照组死亡23例,研究组死亡8例,研究组死亡人数低于对照组（P＜0.05）。死亡组年龄、Killip分级≥Ⅲ级、高血脂、LVEF＜40%、TIMI血流分级≤Ⅱ级占比、白细胞计数、血肌酐水平高于存活组,收缩压、舒张压、血红蛋白、肌钙蛋白I、肌钙蛋白T、CK-MB、LVEF、IABP辅助低于存活组（P＜0.05）。多因素Logistic回归分析显示,年龄≥65岁、Killip分级≥Ⅲ级、LVEF＜40%、TIMI血流分级≤Ⅱ级为患者院内死亡的危险因素（P＜0.05）。结论：IABP辅助支持下的PCI能有效改善AMI合并CS患者心功能,年龄≥65岁、Killip分级≥Ⅲ级、LVEF＜40%、TIMI血流分级≤Ⅱ级为等为其院内死亡危险因素。     

Detection of bone marrow-derived cells in neointimal thickening in the rat carotid artery by nested polymerase chain reaction

The bone marrow origin of cells involved in neointimal formation after injury of the luminal surface of the vessel was confirmed by highly sensitive nested polymerase chain reaction on isolated vascular wall cells. The model of intimal hyperplasia after balloon angioplasty of the carotid artery in radiation bone marrow chimeras between male and female Wistar rats was used. The Y chromosomes of rat male donors of the bone marrow for irradiated females were used as a marker of bone marrow-derived cells. This approach demonstrated a bone marrow origin of a large fraction of α-actin-positive (smooth muscle) neointimal cells.