心脏外科围手术期用主动脉内球囊反搏辅助的相关并发症及危险因素：附12年单中心数据分析

Risk factors of perioperative intra-aortic balloon pump complications in cardiac surgery： a 12-year single-institution analysis

目的分析心脏外科围手术期行主动脉内球囊反搏（IABP）辅助患者并发症的发生情况，以寻找其相关的高危因素。方法回顾性分析2005年1月至2017年1月12年间阜外医院心脏外科围手术期行IABP辅助患者的临床资料，根据有无IABP相关并发症将患者分为两组，收集患者入院一般情况、术前合并症、术中及术后情况、IABP植入时间及辅助时间、并发症发生情况（包括缺血、出血、血管损伤、IABP失功）等。通过logistic回归法分析IABP并发症发生的危险因素.结果12年间共入选522例植入IABP患者，男性388例，女性134例；年龄（61.79±9.35）岁；发生IABP相关并发症25例，发生率为4.79%；院内死亡87例，总体病死率为16.67%，无IABP相关死亡。与无并发症组比较，有并发症组患者女性占比大（40.00%比24.95%），年龄≥65岁者多（80.00%比38.03%），体重指数大（kg/m2：25.45±13.71比22.95±3.45），糖尿病比例高（44.00%比26.76%），行体外膜肺氧合（ECMO）辅助的比例高（20.00%比5.03%），IABP辅助时间长（h：134.4±90.3比109.8±89.1，均P〈0.05），其他指标差异均无统计学意义。术前、术中、术后植入IABP的并发症发生率差异无统计学意义〔3.30%（3/91）、5.46%（10/183）、4.84%（12/248），χ2=0.629，P=0.730〕。植入IABP后出现局部出血14例（2.68%），无严重出血需要输血的病例；出现下肢缺血9例（1.72%）；1例（0.19%）严重血管损伤出现腹膜后出血，手术修复后好转；IABP球囊漏血1例（0.19%），撤除后再次植入反搏良好。logistic回归分析显示，年龄≥65岁〔优势比（OR）=2.320，95%可信区间（95%CI）=1.011~1.806，P=0.047〕、糖尿病（OR=2.281，95%CI=1.016~5.120，P=0.026）、同时行ECMO辅助（OR=4.341，95%CI=1.240~15.196，P=0.040）为IABP并发症发生的独立危险因素。结论IABP相关并发症发生率低，穿刺局部出血和肢体缺血是其常见并发症。高龄、糖尿病及同时应用ECMO辅助者在行IABP辅助期间应严密监测，以减少并发症发生。

ObjectiveTo investigate the incidence and risk factors of the complications in perioperative intra-aortic balloon pump （IABP） supported cardiac surgical patients.MethodsThe clinical data of adult cardiac surgery patients undergoing IABP in Fuwai Hospital from January 2005 to January 2017 were enrolled. The patients were divided into complications group and no complications group. Demographic characteristics, diagnosis, perioperative clinical parameters, IABP related data, and IABP complications （including ischemia, bleeding, vascular injury and mechanical problems） were collected. The incremental risk factors of complications related IABP were analyzed by logistic regression.ResultsDuring the 12-year period, 522 patients received IABP support, with 388 male and 134 female; the mean age was （61.79±9.35） years; the complications related to IABP occurred in 25 patients, and overall complication rate was 4.79%; 87 IABP patients were dead in-hospital, the overall mortality was 16.67%, no patient died due to complications. The complications rate was higher in the female patients （40.00% vs. 24.95%）, and was more in patients with age≥65 years old （80.00% vs. 38.03%）, more with higher body mass index [BMI （kg/m2）： 25.45±13.71 vs. 22.95±3.45], diabetes mellitus （44.00% vs. 26.76%）, combination treatment with extra-corporeal membranous oxygenation （ECMO： 20.00% vs. 5.03%） and prolonged IABP support time （hours： 134.4±90.3 vs. 109.8±89.1, all P 〈 0.05）. There was no significant difference in the incidence of complications among preoperative IABP support, intra-operative IABP support and post-operative IABP support [3.30% （3/91）, 5.46% （10/183）, 4.84% （12/248）, χ2 = 0.629, P = 0.730]. Bleeding from puncture site occurred in 14 cases （2.68%） without severe bleeding. Limb ischemia occurred in 9 cases （1.72%）. One patient （0.19%） was under another surgery because of retroperitoneal hemorrhage caused by vascular injury. One patient （0.19%） was unsuccessful due to a balloon leak. It was shown by logistic regression analysis that presence of age ≥ 65 years [odds ratio （OR） = 2.320, 95% confidence interval （95%CI） = 1.011-1.806, P = 0.047], diabetes mellitus （OR = 2.281, 95%CI = 1.016-5.120, P = 0.026） and combination treatment with ECMO （OR = 4.341, 95%CI = 1.240-15.196, P = 0.040） were found to be the risk factors of complications related to IABP.ConclusionsIABP complication rates are generally low. The frequent complications during IABP support is bleeding from site of catheterization and limb ischemia. When patients were treated with IABP, those with older age, diabetes mellitus and combination with ECMO should be monitored closely in order to reduce complications.