IABP在心脏直视手术围术期低心排的应用

The Application of IABP Therapy for Perioperative LCOS of Open Heart Surgery

为了探讨主动脉内球囊反搏(IABP)治疗心脏手术围术期低心输出量综合征(LCOS)的临床疗效,对16例心脏手术围术期LCOS患者,经过股动脉放置IABP导管于降主动脉内进行左心辅助治疗,IABP治疗前、后监测患者连续有创动脉收缩压(SABP)、有创平均动脉压(MABP)、中心静脉压(CVP)、动脉血氧分压(PaO2)、心率(HR)、尿量和血管活性药物的使用。结果显示,IABP辅助治疗时间25h～116h,平均(78.5±40.5)h。行IABP治疗后,SABP、MABP、PaO2较术前明显提高(P<0.05),HR、CVP明显下降(P<0.05),尿量增加,血管活性药物使用量明显减少(P<0.05),12例患者心功能好转而脱离IABP,11例(69.3%)存活,4例死于心源性休克,1例死于多器官功能不全综合征(MODS)。提示正确及时地使用IABP能明显改善心脏手术围术期LCOS患者的血流动力学指标,减少血管活性药物的使用,建议对有适应证者应尽早应用,适时撤离。

To investigate the clinical efficacy of intra--aortic balloon pumping（IABP）in the treatment of low cardiac output syndrome（LCOS） after open heart surgery. 16 patients with perioperative LCOS had been placed IABP catheter through the femoral artery as a left ventricular assist device, and continuously measurement of systolic arterial blood pressure （SABP）, average arterial blood pressure （MABP）, central venous pressure（CVP）, arterial oxygen tension （PaO2）, heart rate （ HR）, urine volume and the doses of vasoactive agents. The data analysis was done with SPSSll. 5 statistically. The duration of the IABP assist ranged from 25h-116h, mean （78.5±40.5） h. Markedly improved in SABP, MABP and PaO2（P〈0.05） and declined in HR and CVP （P〈0.05} with the IABP undergoing. Meantime urine volume increased and the doses of vasoactive agents reduced. Weaning from IABP successfully was occurred during 12 patients. 11 patients （69.3%） survived,4 patients died of cardiac shock and 1 patient of multiorgan dysfunction syndrome（MODS）. Therefore, IABP applied appropriately can effectively improve the hemodynamic status of patients with perioperative LCOS after open heart surgery. It is suggested that early used and weaned promptly for the indications.