主动脉球囊反搏联合血液净化治疗心脏瓣膜病术后心源性休克

Efficacy of aortic balloon counterpulsation combined with blood purification for the treatment of cardiogenic shock after surgery of cardiac valvular disease

目的研究主动脉球囊反搏联合血液净化对心脏瓣膜病术后心源性休克的临床治疗效果。方法选取2016年11月至2017年11月收治的80例心脏瓣膜病术后心源性休克的患者作为研究对象,随机分为联合组和对照组,各40例。对照组采取血液净化方法进行治疗,联合组在血液净化的基础上,加行主动脉球囊反搏治疗。对比两组患者治疗前后的各项血液动力学指标以及预后指标。结果治疗前两组患者的平均动脉压(MAP)、肺毛细血管楔压(PAWP)、中心静脉压(CVP)、动脉血乳酸(Lac)指标比较无统计学差异(P均>0.05);治疗后联合组的PAWP、CVP、Lac指标均低于治疗前和对照组(P<0.05,P<0.01),MAP高于治疗前和对照组(P<0.05,P<0.01)。联合组ICU病房入住时间、呼吸机辅助时间、住院时间均短于对照组(P均<0.01)。结论主动脉球囊反搏联合血液净化治疗心脏瓣膜病术后心源性休克中有利于改善患者的临床症状,具有较好的临床治疗效果。

Objective To study the clinical efficacy of aortic balloon counterpulsation combined with blood purification for the treatment of cardiogenic shock after surgery of cardiac valvular disease. Methods A total of 80 patients with cardiogenic shock after surgery of heart valvular disease admitted from November 2016 to November 2017 were selected as research objects. The patients were randomly divided into combination group（n = 40） and control group（n = 40）. The blood purification treatment was used in control group,and aortic balloon counterpulsation treatment was added on the basis of blood purification treatment in combination group. The hemodynamic indexes and prognostic indicators before and after treatment were compared between two groups. Results There were no significant differences in mean arterial pressure（MAP）,pulmonary capillary wedge pressure（PAWP）,central venous pressure（CVP） and arterial blood lactic acid（Lac）before treatment between two groups（all P〉0. 05）. Levels of PAWP,CVP and Lac after treatment in combination group were significantly lower than those in control group and before pulmonary（P〈0. 05,P〈0. 01）,and the level of MAP after treatment in combination group was significantly higher than that in control group and before pulmonary（P〈0. 05,P〈0. 01）. The ICU stay time,respirator auxiliary time and hospital stay in combination group were significantly lower than those in control group（all P〈0. 01）. Conclusion Aortic balloon counterpulsation combined with blood purification is in favour of improving patients＇ clinical symptoms and has a better clinical therapeutic effect for cardiogenic shock after surgery of cardiac valvular disease.