主动脉内球囊反搏在治疗冠状动脉搭桥术后低心排出量中的应用

Application of Intra-aortic Balloon Pump in Low Cardiac Output after Coronary Artery Bypass Surgery

目的评价主动脉内球囊反搏(IABP)在治疗冠状动脉搭桥术后低心排出量中的应用。方法回顾性分析32例冠状动脉搭桥术后低心排出量的综合治疗措施,比较应用IABP与药物治疗的疗效。对治疗前后舒张压、平均动脉压、心脏指数进行统计学分析。结果应用IABP 1 h后舒张期反搏压达到75~110 mm Hg,心脏指数从(1. 75±0. 16) L·min^(-1)·m^(-2)上升到(2. 33±0. 26) L·min^(-1)·m^(-2)(P <0. 05),平均动脉压从(46. 8±15. 2)mm Hg上升到(83. 4±23. 6) mm Hg(P <0. 05),临床表现也出现明显的改善。共死亡10例,依赖IABP死亡2例,单纯药物治疗死亡8例。IABP并发症发生4例,经治疗后恢复。结论 IABP能显著地增加冠状动脉供血,改善冠脉循环,降低心脏后负荷,减少心脏作功和耗氧,最终增加心输出量。因此,与单纯药物相比,IABP是治疗冠状动脉搭桥手术后低心排出量的有效手段。

Objective To evaluate the application of intra-aortic balloon pump in low cardiac output after coronary artery bypass surgery.Methods The comprehensive treatment of 32 patients with coronary artery bypass were retrospectively analyzed and the effect of IABP and drug therapy was compared. The diastolic blood pressure, average arterial pressure and cardiac index were analyzed.Results The diastolic blood pressure was 75-110 mmHg after the application of IABP one hour, cardiac index from（1.75±0.16） L·min -1 ·m -2 up to （2.33±0.26） L·min -1 ·m -2 （ P 〈0.05）, average arterial pressure, from （46.8±15.2 ） mmHg up to （83.4±23.6） mmHg（ P 〈0.05）, the clinical manifestation were also a significant improvement. There were 10 cases of total death,included 2 cases of IABP death and 8 cases of pure drug treatment. There were 4 cases of IABP complications, and then recovered after treatment.Conclusion IABP can significantly increase the blood supply of coronary arteries, improve the coronary circulation, reduce the cardiac post-load, reduce the cardiac work and oxygen consumption, and ultimately increase the cardiac output. Therefore, IABP is an effective method for the treatment of low cardiac output after coronary artery bypass surgery.