主动脉内球囊反搏技术救治高危冠状动脉旁路移植术患者

Role of intra-aortic balloon pump in management of high-risk intra-aortic balloon pump patients during peri-operative period

目的探讨围手术期应用主动脉内球囊反搏(intra-aortic balloon pump,IABP)对高危冠心病患者冠状动脉旁路移植术(coronary artery bypass graft,CABG)患者救治的效果。方法回顾性分析IABP对42例CABG围手术期患者的临床反应、血流动力学以及病死率的影响。结果平均IABP辅助时间(87±16)h,辅助期间平均动脉压(MAP)明显升高,心率降低、心排血量指数增加,术中及术前使用可改善心脏不停跳冠状动脉旁路移植术过程中,心脏对稳定器压迫的耐受性,同时使心脏功能差的患者顺利脱离体外循环。34例康复出院,住院死亡8例,主要死亡原因为低心排血量综合征、多器官功能衰竭等。结论IABP是一种简单有效的循环辅助手段,心功能差的高危CABG患者应积极地放置IABP。

AIM To investigate the role of intra-aortic balloon pump （IABP） in the management of high-risk coronary artery byeass graft（CABG） patients during peri-operative period. METHODS Forty-two high-risk coronary artery disease patients with IABP support during CABG procedure were included in this study. Their clinical manifestation, homodynamic data and death rate were retrospectively analyzed. RESULTS The mean time of IABP support was （87 ± 15 ）h. With IABP support, the mean artery pressure and cardiac index significantly increased and the heart rate slowed down. IABP, set up before or during the operation, could improve the tolerance of the heart to the holder oppression during off pump coronary artery bypass and made the patients much easier to wean from the cardio-pulmonary bypass. Thirty-four patients were discharged rehabilitatively. Eight patients succumbed to low cardiac output symptom or multiple organ failure and died. CONCLUSION IABP is a simple and effective circulation assistance device and its use should be encouraged in the management of high-risk CABG patients.