主动脉内球囊反搏在心脏外科应用失败的原因分析

Study on the failured IABP support cases for low output syndrome in cardiac surgery

目的:研究分析主动脉内球囊反搏(IABP)在心脏手术围术期低心排综合征中救治失败的原因。方法:回顾性分析47例心内直视术患者围术期应用IABP的临床资料,分为成功组(30例)和失败组(17例)两组,比较IABP植入前后的血流动力学数据和正性肌力药物剂量、动脉血气分析结果及肾功能指标。结果:失败组中16例(94.1%)术前心功能为NYHAⅢ或Ⅳ级,11例(64.7%)未能及时植入IABP,10例(58.8%)平均动脉压<60mmHg,16例(94.1%)多巴胺用量>10μg/(kg.min),12例(70.6%)肾上腺素用量>0.10μg/(kg.min),12例(70.6%)尿量<1ml/(kg.h),11例(64.7%)合并难治性代谢性酸中毒。与成功组相比差别有显著性。结论:IABP是救治重症低心排综合征有效的机械辅助手段。心功能恶化,正性肌力药物无效时,应及时置入IABP,如延误植入时间,或患者已经出现肾功能衰竭、内环境紊乱、心功能严重受损,则会明显降低救治成功率。

Objective：To study the causes for failured IABP support for perioperative low cardiac output syndrome. Methods：A retrospective analysis was performed on 47 patients who underwent cardiac operations and accepted IABP support during the perioperative period. The patients were classified into 2 groups： successful group （n bles including patients＇ hemodynamic parameters, ： 30） and failured group （n = 17）. Clinical variadosage of positive cardiotonic drugs, blood gases and parameters of renal function were recorded and analyzed. Results： In failured group, 16 （94.1%） patients were in NYHA function class Ⅲ or Ⅳ, 10 （58.8%） had a mean arterial pressure 〈60mmHg. IABP was implanted too late in 11 patients （64.7%）. The dose of dopamine used in 16 patients （94.1%） was 〉10μg/（kg · min） and the dose of epinephrine was 〉0.10μg/（kg · min） in 12（70. 6%）. The urine output of 12 patients （70. 6%） was 〈1ml/（kg · h） and 11 patients （64.7%） developed refractory metabolic acidosis. Compared to the successful group, P〈0.05. Conclusion： IABP is a useful aid device for patients who develop serious low cardiac output syndrome. IABP should be implanted as soon as possible when patients show low cardiac output syndrome refractory to medication. Delayed implantation and complications of disruption of homeostasis, acute renal failure, severely damaged cardiac function may lead to failure.