体外循环后血管麻痹综合征的诊治

Diagnosis and treatment of vasoplegic syndrome after cardiopulmonary bypass

目的 总结体外循环后血管麻痹综合征的诊断及其治疗经验。方法 1999年 1月至 2 0 0 2年 4月共发生6例体外循环后血管麻痹综合征 ,结合有关文献 ,对体外循环后血管麻痹综合征的临床表现和治疗经验进行总结。结果 在体外循环后早期 ,6例均出现的以严重低血压伴血液动力学高排低阻为特征的现象。 2例由于认识水平有限 ,治疗欠佳 ,逐步出现全身多脏器功能障碍 ,最终导致死亡。 4例确诊后 ,立即开始大剂量收缩血管药物治疗 ,成功抢救后平顺出院。结论 体外循环后血管麻痹综合征的发生率不高 ,但是处理不当其后果是严重的 ,因此 ,在临床工作中对它要有充分的认识 ,做到判断准确。

Objectives To review the expe rience of diagnosis and management for vasoplegic syndrome after cardiopulmonary bypass. Methods The vasoplegic syndrome in 6 cases occured from January 1999 to April 2002. Combinating relative references, we commented the clinical features and treatment experience for vasoplegic syndrome after cardiopulmonary bypass.Results We have observed the vasoplegic syndrome in 6 cases during the early postoperative period with severe hypotension and normal or elevated cardiac output, decreased filling pressures, and low systemic vascular resistance, but normal capillary filling at the extremities and normal oxygen saturation. 2 patients were dead because of incorrect diagrosis or management, the 4 others survived because of being managed with a big dosage of vasoconstrictor drugs for hours or even days in time. Conclusions Despite its infrequent appearance, the deleterious effects of the vasoplegic syndrome, as well as its mortality, have been worrisome. So we should give more attention to this syndrome. The treatment with intravenous vasoconstrictor is necessary in time once it developed.