心脏围术期应用主动脉球囊反搏40例临床观察

Perioperative effect of the intra-aortic balloon pump in 40 patients during the cardiac surgery

目的探讨主动脉内球囊反搏(IABP)在心脏外科危重患者中应用指征、疗效及并发症防治。方法我院2008年4月至2011年10月的心脏手术围术期应用IABP 40例,其中冠心病28例;瓣膜病10例(包括同时合并冠心病4例),复杂先心病2例。结果 IABP辅助时间18.5～168(68±42)h。36例患者成功撤除IABP,脱机率90%。死亡10人,其中6例已成功撤除IABP,死于其他并发症,4人未撤除IABP。并发症为血小板(PLT)减少10例,下肢缺血1例。结论 IABP可有效改善危重心脏病患者围术期血流动力学,对冠心病围术期并发低心排综合征(LCOS)效果最佳,术前预防性植入及尽早使用可明显降低死亡率。

Objective To explore the indication,application and complication of intra-aortic balloon pump（IABP）in high risk patients undergoing cardiac operations.Methods From June 2008 to October 2011,40 patients were performed IABP in the cardiac surgery,including 28 coronary artery bypass grafting（CABG）,8 valve replacements and 2 complex congenital heart diseases.Results The time of using IABP was 18.5-168（68 ± 42）hours.36 cases removed IABP successfully.The rate of removal IABP was 90%.10 cases were died,and the rescue rate was 75%.6 cases removed IABP while died for the operation complications,and 4 cases did not remove IABP for low cardiac output syndrome.Complications related to IABP occurred,including thrombocytopenia in 10 cases and lower extremity ischemia in 1 case.The complications have improved after stopped IABP and removed sheath respectively.Conclusion Application of IABP in the serious patients undergoing cardiac operations can obtain good circulation support,it has better effect in coronary heart disease with low cardiac output syndrome.By prophylactic and early use of IABP,mortality can be reduced.