主动脉内球囊反搏在心脏外科围术期的临床应用

Clinical application of intra-aortic balloon counterpulsation in 40 cases during perioperative period of cardiac surgery

目的:探讨主动脉内球囊反搏术(IABP)在心脏外科围术期患者出现低心排血量综合征时应用的有效性及可行性。方法:回顾性分析40例使用IABP的原因及使用12h、24h、48h后平均动脉压(MAP)、心脏指数(CI)、肺动脉嵌压(PAWP)、氧输送指数(DO2I)、氧摄取率(O2ER)等血流动力学指标变化。结果:与IABP前比较,IABP 12h、24h、48h后MAP[48h:(56.40±6.51)mmHg比(73.00±3.36)mmHg]、CI[48h:(1.74±0.21)L.min-1.m-2比(2.74±0.21)L.min-1.m-2]、DO2I[48h:(267.36±15.95)ml.min-1.m-2比(429.60±33.19)ml.min-1.m-2]均明显升高,尿量[48h:(25.44±3.88)ml/h比(99.48±9.48)ml/h]明显增加,PAWP[48h:(18.00±1.66)mmHg比(12.60±0.71)mmHg]、O2ER[48h:(44.45±4.00)%比(31.41±1.25)%]均明显下降(P均<0.01)。40例中死亡7例(19.5%)。结论:主动脉内球囊反搏术可有效改善血流动力学,对于围术期低心排患者的治疗安全且有效。

Objective： To explore validity and feasibility of intra-aortic balloon counterpulsation （IABP） in patients occurring low cardiac output syndrome during perioperative period of cardiac surgery. Methods： Application cause of IABP in 40 cases and changes of hemodynamic indexes, such as mean arterial pressure （MAP）, cardiac index （CI）, pulmonary arterial wedge pressure （PAWP）, oxygen delivery index （DO2 I） and oxygen uptake rate （O2 ER） after 12h, 24h and 48h were retrospectively analyzed. Results： Compared with before IABP, there were significant increase in MAP [48h ： （56.40±6.51） mmHgvs. （73.00±3.36） mmHg], CI [48h： （1. 74± 0. 21） L. min-1 . m-1 vs. （2.74±0.21） L. min-1 . m-1], DO2I[-48h： （267.36±15.95） ml. min-1 . m-1 vs. （429.60±33.19） ml . min-1. m- 1 ] and urine amount [48h： （25.44 ± 3.88） ml/h vs. （99.48 ± 9.48） ml/h], and significant decrease in PAWP [48h： （18. 00±1.66） mmHg vs. （12.60 ± 0.71） mmHg] and O2ER [48h： （44.45 ± 4.00）% vs. （31.41 ± 1.25）%] at 12h, 24h and 48h after IABP, P〈0.01 all. Seven patients died in these 40 patients （17.5%）. Conclusion： Intraaortic balloon counterpulsation can effectively improve hemodynamic and it＇s safe and effective in patients occurring low cardiac output syndrome during perioperative period of cardiac surgery.