主动脉内球囊反搏治疗重症瓣膜病瓣膜置换术后心肌顿抑

Treatment for Myocardial Stunning by IABP on Patients with Severe Valvular Heart Disease after Valve Replacement

目的探讨主动脉内球囊反搏(IABP)治疗重症瓣膜病瓣膜置换术后心肌顿抑的疗效。方法对2006年1月至2013年12月行瓣膜置换术后发生心肌顿抑应用IABP治疗的15例患者的临床资料进行回顾性分析。比较IABP治疗前后收缩压、平均动脉压、肺毛细血管楔压、心脏指数、中心静脉压、尿量和多巴胺用量等指标的变化。同时观察患者IABP应用过程中并发症、预后等情况。结果术中应用IABP者5例,术后应用IABP者10例。其中死亡1例,患者术前为恶液质合并巨大左心室,心功能IV级,术后发生心肌顿抑,经IABP治疗仍不能纠正,引起低心排血量综合征,诱发多脏器衰竭而死亡。余14例均治愈,未出现IABP严重并发症。置入IABP后,血流动力学指标、尿量较应用IABP前明显改善,多巴胺用量逐渐减少,差异有统计学意义(P<0.05)。术中应用IABP与术后应用IABP比较,入住ICU时间和应用呼吸机辅助时间明显减少、住院时间明显降低,差异有统计学意义(P<0.05);应用IABP辅助时间和病死率差异无统计学意义。结论 IABP是治疗心脏重症瓣膜病瓣膜置换术后心肌顿抑的安全、有效的方法。

Objective To investigate the curative effects of intra-aortic balloon pump（ IABP） on patients with myocardial stunning after valve replacement for severe heart valve lesions. Methods The clinic data of 15 patients who underwent IABP therapy occurred myocardial stunning after valve replacement was retrospectively analysed from January 2006 to December 2013. Systolic blood pressure（ SBP）,mean arterial pressure（ MAP）,pulmonary capillary wedge pressure（ PAWP）,cardiac index（ CI）,central venous pressure（ CVP）,urine volume and dosage of dopamine were compared before and after the IABP treatment. The complications and prognosis were also observed. Results IABP were used in 5 cases during the operation,and in 15 cases after the operation. One patient with giant left ventricle,died of low cardiac output syndrome secondary to myocardial stunning,and eventually occured multiple organs failure. The remaining 14 cases were cured successfully and no serious complications of IABP were observed. After the support of IABP,hemodynamic index and urine volume were improved significantly,and the dopamine dosage was decreased significantly（ P〈0. 05）. Compared with patients who apply IABP after operation,those patients who received IABP support during the operation had the shorter mechanical ventilation time and ICU time（ P〈0. 05）,and the time of hospitalization was decreased greatly,but there were no significant difference both the IABP support time and mortality. Conclusion IABP is a safe and effective method to treat myocardial stunning after cardiac valve replacement.