机械循环辅助装置治疗围手术期急性心肺功能衰竭

The therapeutic effects of various circulatory support devices in acute cardiorespiratory function failure patients during perioperation of cardiosurgery

目的:观察心室辅助(VAD)、体外膜式氧合(ECMO)及主动脉内气囊反搏(IABP)等机械循环辅助装置治疗围手术期急性心肺功能衰竭的疗效。方法:回顾2005年1月至2006年12月我院心脏外科监护病房224例围手术期进行循环辅助患者临床资料,VAD4例、ECMO47例及IABP173例。结果:VAD死亡2例(50%),ECMO死亡23例(48.9%),IABP死亡49例(28.3%)。并发症为感染27例、肾功能衰竭需要透析26例、出血23例、下肢缺血15例及脑并发症7例。结论:机械辅助是救治围手术期急性心肺功能衰竭的有效方法,应根据患者病情选择适合的辅助方式并及早放置,防治并发症对提高成功率非常重要。

Objective： To investigate the therapeutic effect of various circulatory assist devices in acute cardiorespiratory function failure patients during perioperation of cardiosurgery. Method： From January 2005 to December 2006, 224 patients [54 female; mean age （57.7 ± 14.1） years] received circulatory support for perioperative cardiorespiratory function failure at our ICU. Biventricular assist devices （BiVADs） was used in one patient for fulminant myocarditis as a direct bridge to heart transplantation, and 3 patients received a left ventricular assist device （LVAD） for postcardiotomy cardiac function failure. ECMO was established in 47 patients for postcardiotomy cardiorespiratory function failure. Venoarterial bypass was instituted in 45 for hemodynamic failure and venovenous in 2 patients for hypoxemia following cardiac surgery. Seven patients received IABP support during ECMO. 173 patients received IABP support for perioperative cardiac function failure. The cardiac operations included coronary artery bypass grafting （ n = 150）, coronary artery bypass grafting and remolding of left ventricle（ n = 21 ）, coronary artery bypass grafting and valvular operation （n = 8 ）, valvular operation alone （n = 26 ）, heart transplantation （ n = 8）, correction of congenital heart defects （ n = 7）, and aortic operations （ n = 2）. Result： In the VAD group, the patient successfully weaned from BiVADs but died of disseminated intravascular coagulation （DIC） after transplantation. One patient died on LVAD for heart failure. In the ECMO group, 16 patients died on ECMO and 7 patients died after weaning because of multiple organ failure. In the IABP group, 49 patients died with 18 patients survivaled to decannulation. The most common complications were infection （ n = 27 ）, renal failure required renal replacement therapy （ n = 26）, re-exploration for bleeding （ n = 23）, limb ischemia （ n = 15） and central nervous system complication（ n = 7）. Conclusion： Circulatory assist devices is an effective mechanical assistance method for treatment of perioperative cardiorespiratory failure. Adapted assist devices should be preferred according to patient＇ s condition. Consideration should be iven to institutina circulatory assist devices earlier if indication is confirmed.Improvement of management may result in improved outcomes for advanced cardiorespiratory function failure.