28例瓣膜置换术后顽固性低心排应用IABP的临床分析

The therapy of low cardiac output syndrome( LCOS) after cardiac valve replacement with application of the Intra-aortic balloon pump( IABP)

目的:探讨心脏瓣膜置换术后出现顽固性低心排量综合征(LOCS)的治疗方法及应用主动脉内球囊反搏(Intra-aortic balloon pump,IABP)辅助的疗效分析。方法:本组28例瓣膜置换术后LOCS患者在药物纠治无效时均使用IABP辅助,并对辅助前后的循环指标及血管活性药物使用情况进行对比,同时观察应用IABP的相关并发症及预后等情况。结果:28例患者使用IABP后循环指标均改善,血管活性药物使用量减少,使用前后对比有统计学意义(P<0.05),其中11例(39.28%)患者IABP辅助后期心功能仍无法恢复,低心排致多器官功能障碍死亡。17例存活患者应用IABP均出现不同程度的肺部感染,其中5例行气管切开。结论:心脏瓣膜置换术后低心排量综合征患者应用IABP辅助,可减少心脏负荷,改善血流动力学指标,有助于心脏收缩功能恢复,改善重要脏器循环,提高抢救成功率,改善预后。IABP是成功救治心脏瓣膜置换术后低心排量综合征患者的重要手段。

Objective：To explore the therapy of low cardiac output syndrome（ LCOS）after cardiac valve replacement with application of the Intra-aortic balloon pump（ IABP）. Methods：28 patients,ineffectively cured in drug therapy,with low cardiac output syndromes after cardiac valve replacements were performed. Before and after the IABP,the complication and prognosis in the application process of IABP were observed. Results：The circulatory system of 28 patients recovered, and the use of vasoactive drug reduced,which was of statistical significance before and after using the drug（P﹤0. 05）. The cardiac function 11 patients had not recovered during the late stages of IABP,died of multiple organ dysfunction by LCOS. 17 survived by IABP are of different degrees of lung infection,of which,5 were applied by tracheotomy. Conclu-sion：For the patients with low cardiac output syndrome after cardiac valve replacement,the application of IAMP may reduce cardiac load,improve the index of haemodynamics,contribute to the recovery of systolic function,improve the circu-lation of vital organs,increase survival rate and amend prognosis. IAMP is of significance to save patients who have low cardiac output syndrome after cardiac value replacement.