冠状动脉旁路移植术实施主动脉内球囊反搏时机的选择

Optimal timing for perioperative internal aortic balloon pumb support in high-risk coronary artery bypass grafting

目的总结在冠状动脉旁路移植术（CABG）围手术期实施主动脉内球囊反搏（IABP）的临床经验，探讨此类手术应用IABP的时机选择和适应证。方法15例冠心病患者在IABP支持下，实施CABG。8例术前实施了IABP，术前实施时间1～2d，其中1例心肺复苏成功后实施IABP，2例急性心肌梗死后出现低心排血量综合征实施IABP，5例在术前出现急性冠脉综合征实施IABP；7例为术中、术后实施IABP，其中6例在术中实施IABP，另有1例在术后24h实施IABP。结果8例术前实施IABP者，无一例死亡，术后1～6d撤除IABP，恢复良好，痊愈出院；7例术中、术后实施IABP者有3例于术后1～3d死亡。全组平均搭桥3．4根，术后于ICU监护2～5d，平均使用IABP辅助时间（39．3±4．2）h。全组无明显IABP并发症。结论CABG围手术期实施IABP可以有效地改善心功能，提高重症患者的手术成功率；重症患者IABP越早实施效果越好，术前实施效果明显比术中、术后实施效果更明显。

Objective To study the clinical experience and determine the optimal timing for perioperative internal aortic balloon pumb （IABP） support in high-risk patients who had coronary artery bypass grafting （CABG） had been demonstrated. Methods Fifteen cases of emergency CABG with IABP were performed from September 2003 to April 2008. Eight cases were supported by IABP before operation,1 case was supported after succeeding in cardiopulmonary resuscitation,2 cases were supported by IABP for acute myocardial infarction,5 cases were supported by IABP for acute coronary syndrome. Seven cases were supported by IABP in the time of intra-or postoperation,2 cases were supported by IABP in order to help removing cardiopulmonary bypass in the operation. Result Three cases supported by IABP in the time of intra-or postoperation were dead, the other 12 cases were healed. Conclusions IABP can improve the heart function effectively and therefore can increased the success rate of operation.The beneficial effect of preoperative IABP in high-risk patients who have CABG is confirmed.