主动脉内球囊反搏联合小剂量呋塞米在重症瓣膜置换术后低心排血量综合征中的应用

Application of intra aortic balloon pump combined with low dose of furosemide in patients with low cardiac output syndrome after severe valvular replacement

目的研究主动脉内球囊反搏(intra aortic balloon pump,IABP)联合小剂量呋塞米持续静脉泵入治疗重症瓣膜置换术后并发低心排血量综合征的应用效果及治疗经验。方法选取2008年12月至2016年11月在东莞康华医院心外科住院86例(男45例,女41例,年龄33~76岁)重症瓣膜置换术后并发低心排血量综合征的患者作为研究对象,按随机数字表法分为两组:对照组(44例)在常规强心、扩血管、营养心肌等治疗基础上单纯应用IABP辅助;实验组(42例)在对照组基础上联合小剂量呋塞米(0.01~0.05 mg·kg^(-1)·h^(-1))持续静脉泵入治疗。观察比较两组间IABP辅助时间、心率、有创平均压、肾上腺素使用剂量及心指数、尿量、肾功能(肌酐值)、中心静脉压,乳酸的变化情况。结果与对照组比较,实验组的病死率较低;IABP辅助的时间较短、肾上腺素的使用剂量较小、肾功能(肌酐值)的变化范围波动较小,心率及中心静脉压、乳酸浓度等下降明显,有创平均压、尿量、心指数等显著升高,差异均有统计学意义(P<0.05)。结论 IABP联合小剂量呋塞米静脉持续泵入治疗重症瓣膜置换术后并发低心排血量综合征患者的心功能改善更明显,血流动力学更稳定;机械辅助时间较短,减少围术期严重心律失常等并发症,可以提高重症瓣膜病患者的瓣膜置换术的手术成功率。

Objectives To study the application results and treatment experience of intra aortic balloon pump（IABP）combined with low dose of furosemide treated by continuous intravenous infusion in patients with low cardiac outputsyndrome after severe valvular replacement. Methods Totally 86 patients with low cardiac output syndrome after severevalvular replacement were selected from December 2008 to November 2016 in Dongguan Kanghua Hospital（male 45 cases,female 41 cases,age 33-76 years old）. The patients were randomly divided into two groups：control group（44 cases）treated with simple application of IABP in conventional cardiac,vasodilation and myocardial nutrition basicaltreatment;experiment group（42 cases）continuously treated with small dose of furosemide（0.01-0.05 mg·kg^-1·h^-1）by intravenous infusion based on the treatment of control group. IABP auxiliary duration and heart rate（HR）,meanarterial blood pressure（MABP）,adrenaline dose and cardiac index（CI）,urine volume and renal function（creatinine）,central venous pressure（CVP）,lactic acid（Lac）changes were observed and compared between the two groups.Results Compared with control group,mortality rate of experimental group was lower,IABP auxiliary duration wasshorter,using dose of epinephrine was lower,fluctuations range of renal function（creatinine）was smaller;HR,CVP,Lac,etc. decreased significantly;MABP,urine volume,CI significantly increased,the differences had statistical significances（P0.05）. Conclusions Patients with low cardiac output syndrome after severe valvular replacementtreated with IABP combined with small dose of furosemide intravenous infusion in surgical treatment,of whom the heartfunction is improved obviously,hemodynamics is more stable;duration of mechanical assistance becomes shorter,severe arrhythmia and complications at perioperative period are reduced,success rate of surgical valve replacement inpatients with severe valvular heart disease is improved.