机械辅助循环在治疗心力衰竭患者中的作用

Clinical application of mechanical circulatory support in the treatment of heart failure

目的探讨机械辅助循环用于临床药物治疗无效的心力衰竭患者的作用。方法1999年1月至2005年8月，本院共有26例患者应用机械辅助循环。在26例患者中，男性17例，女性9例，年龄11～72（48．5±9．8）岁。术前心功能NYHA分级：Ⅲ级5例，Ⅳ级21例。辅助循环原因：术中不能停体外循环者10例，术后严重低心排7例，术后顽固性心律失常1例，终末期扩张性心肌病7例，肥厚性心肌病反复心搏骤停1例。辅助循环方式：左心辅助15例，右心辅助2例，双心辅助2例，体外膜肺氧合4例，左心辅助＋主动脉内球囊反搏3例。结果17例使用离心泵或体外膜肺氧合者，11例脱离辅助循环出院，6例死亡均为并发多器官功能障碍综合征。9例应用体外型及全植入式人工心脏者，6例术后可携带心室辅助装置自由活动。在全部患者中，2例心功能恢复撤机出院；1例携带人工心脏出院，在等待移植中死亡；1例过渡到心脏移植，在移植后15d死于脑栓塞。早期死亡3例，晚期死亡4例。结论机械辅助循环为治疗心衰有效手段，应强调早期使用，促使心功能恢复或过渡到心脏移植。

Objective To study the effects of mechanical circulatory support in the treatment of heart failure. Method From January 1999 to August 2005, 26 patients received mechanical circulatory support. There were 9 female and 17 male patients, with age of （48.5 ± 9.8） （11 to 72） years old, 5 patients with function NYHA class Ⅲ , and 21 with class Ⅳ . Of them, there were 10 patients with CPB-dependence, 7 with low cardiac output syndrome after operation, one with severe arrhythmia, 7 with end-stage dilated cardiomyopathy, and one with cardiac arrest because of hypertrophic obstractivc cardiomyopathy. Left ventricular assist device （LVAD） were used in 15 patients, right ventricular assist device （RVAD） in 2 patients, biventricular assist devices （BVAD） in 2 patients, extracorporeal membrane oxygenation （ECMO） in 4 patients, and LVAD with intraaortic baloon pump （IABP） in 3 patients. Results Eleven of the 17 patients with ECMO or centrifugal pump were discharged from hospital, and 6 died of multiple organ dysfunction. In the 9 patients who reeeived Berlin Heart VAD, 6 could make free activity with VAD. Among all the patients, 2 were discharged with cardiac function recovery, one was discharged with VAD and died during waiting for transplantation, and one needed heart transplantation but died after transplantation. Three died at the early stage, and 4 died at late phase. Conclusions Mechanical circulatory support could significantly improve cardiac function but should be used early in the treatment.