主动脉内气囊反搏术48例临床分析

Intra-aortic balloon pumping in 48 patients with heartfailure

作者采用主动脉内气囊反搏术（ＩＡＢＰ）救治心脏泵衰竭４８例，包括风湿性心脏病３９例，先天性心脏病７例，冠心病２例。多是心内直视手术后泵衰竭，平均每例使用ＩＡＢＰ２７小时。存活２３例（４８％），存活者经ＩＡＢＰ后，临床生命体征迅速好转稳定，血流动力学参数明显改善：心排出量增加５０％，心指数增加６０％，每搏心输出量增加５５％，每搏指数增加６０％，左房压与肺毛嵌入压下降。死亡２５例（５２％），心律紊乱和肾功能衰竭是重要的致死原因。ＩＡＢＰ的并发症与股动脉插管方式有密切关系，插管侧下肢缺血是主要的并发症。作者认为，除使用ＩＡＢＰ要及时外，还要重视心律紊乱和肾衰的防治。对频发室性早搏者，同时使用心脏临时起搏器与ＩＡＢＰ，可取得一定的疗效。对插管侧下肢缺血，要及时作出鉴别诊断和处理。

Abstract48 patients with heart failure were supported byintra-aortic balloon pumping(IABP)from 1985 to1993.The dicease included rheumatic(39 patients),congenital(7)and coronary hearts(2).The averagetime of supporing with IABP was 27 hours.23 patients(48%)survied inclading 19 patients with postoperativelower cardiac output syndrome. Hemodynamics wasimproved. IABP increased cardiac output syndrome,and hemodynamics was improved,IABP increasedcardiac output(50%),cardiac index(60%),strokevolume(50%),stroke volume index(6O%)and de-creased left atrial pressure or pulmonary wedge pres-sure. The mortality was 25 patients(52%).The deathcauses were as follows:arrhythmia(4),renal failure(6),lung failure(2),DIC(1),and the other (12).The main complication of IABP was lower limb is-chemia particularly in surgical cut-down method to es-tablish IABP,The analysis indicated that the tempo-rary pacing maker with IABP could prevent some ar-rhythmia such as frequent premature ventricular beats.Lower limb ischemia and renal failure should receive much attention because they are easy to be confusedwith shock symptom when IABP.