心脏直视手术后严重低排患者的机械辅助循环

Mechanical Circulation Assistance for Severe Low Cardiac Output Syndrome Following Cardiac Operation

对７例因严重低排无法脱离体外循环（ＣＰＢ）患者应用不同方式机械辅助循环治疗。其中６例顺利脱离ＣＰＢ，５例存活，２例死亡；７例机械辅助循环（ＭＣＡ）时间６～９６小时，平均３７．１小时。１例穿刺侧右下肢有缺血并发症。对术前心功能和术中心肌保护较差的患者应尽早做好ＭＣＡ准备；药物抗低排效果不良时立即行ＩＡＢＰ，效果不明显时ＩＡＢＰ与左心辅助（ＶＡＤ）同时进行。当血流动力学稳定时尽早撤除ＭＣＡ，ＭＣＡ期间ＡＣＴ维持在２００秒左右即可，普通滚压泵亦可用于ＶＡＤ。

In recent years, we have used different methods of mechanical circulation assistance (MCA) in treating 7 patients who suffered severe low cardiac output syndrome (LCOS)and CPB be discontinued. Of these patients,CPB stopped smoothly in 6 cases; 5 survived and 2 died.MCA time of 7 cases was 6-96 hours,mean 37.1 hours. One case had isochemia of right lower extremity.The author claim that preoperation for MCA should be done early when patient's preoperative cardiac function is very polr and myocardial protection isn't satisfactory during operation. Intraaortic BalloonCounterpulsation (IABP) is performed as soon as possible when medication is ineffective on LCOS. If IABP can't makehemodynamics stable; IABP and Left Ventricular Assist Device must be taked together; MCA should be withdrowed early when emodynamics stable, It's suitable for ACT to maintain around 200' during MCA; The roll-pump also can be used in Left Ventricular Assist Device satisfactorily.