主动脉内球囊反搏在重症瓣膜病术后低心排量综合征中的应用

Intra-aortic balloon pump in treatment of low cardiac output syndrome following heart surgery in the patients with severe valvular heart disease

目的观察主动脉内球囊反搏（intra-aortic balloon pump，IABP）在重症心脏瓣膜病术后出现低心排量综合征（low cardiac output syndrome，LCOS）时的应用效果。方法 回顾性分析本研究所2009年1月至2014年1月共7 000余例中接受心脏瓣膜手术后出现LCOS并应用IABP进行抢救的19例患者的临床资料。该组患者术前心脏超声检查均提示联合瓣膜病变，至少1个瓣膜为重度，均在常规低温体外循环、心脏停搏下行瓣膜手术。结果 19例患者IABP治疗时间9～126 h，死亡3例（15.8%），其中2例为多脏器功能衰竭，1例患者死于严重肺部感染；无1例出现与IABP相关严重并发症。患者IABP置入3 h后平均动脉压（MABP）、中心静脉压（CVP）、心输出量（CO）均较前明显改善（P〈0.05）；多巴胺、肾上腺素等血管活性药物用量明显减少（P〈0.05）；尿量逐渐增加，动脉血乳酸值达到高峰后（一般为3～6 h）逐渐下降。结论 IABP是一种安全、有效的心脏外科围术期辅助循环支持手段。对重症心脏瓣膜病术后出现低心排量综合征的患者及时、正确地应用IABP，可明显改善患者血流动力学指标，降低病死率。

Objective To summarize the effect of the intra-aortic balloon pump （IABP） in the treatment of low cardiac output syndrome （LCOS） in the patients with severe valvular heart disease after heart surgery. Methods From January 2009 to January 2014, more than 7 000 patients underwent valve replacement in our department. Among them, 19 patients were performed IABP support because of LCOS after operation. Their preoperative echocardiography showed combined valvular lesions, with at least 1 valve of severe malformation. These 19 cardiac operations were performed under the hypothermic cardiopulmonary bypass and cardiac arrest. Results The IABP support time was ranged from 9 to 126 h in these 19 cases. Three patients died （15.8%）, and 2 cases died of multiple organ failure and the left 1 of severe pneumonia. There was no IABP associated complication in the cohort. Conclusion IABP is a safe and effective mechanical assist device during cardiac operative procedures. If the patients with severe valvular heart disease encounter with LCOS after cardiac valve replacements, IABP should be exactly and actively applied, which may improve the index of haemodynamics and reduce the mortality．