冠状动脉旁路移植术后主动脉内球囊反搏联合体外模肺氧合辅助患者并发症分析

Analysis of complications relate-to intra-aortic ballon pump plus extracorporeal membrane oxygeuation support in patients after coronary artery bypass grafting

目的:总结冠心病患者行冠状动脉旁路移植术(CABG)后应用主动脉内球囊反搏(IABP)联合体外模肺氧合(ECMO)辅助相关并发症情况和护理经验。方法:回顾性分析96例CABG术后行IABP联合ECMO辅助患者的临床和护理资料,观察机械辅助前后生理指标变化、并发症及转归情况,总结护理经验。结果:机械辅助后患者的生理指标显著改善LVEF[(47.36±5.10)%vs.(29.60±4.52)%];收缩压[(108.20±12.49)vs.(73.88±20.62) mmHg,1 mmHg=0.133 kPa];舒张压[(61.58±8.14)vs.(38.40±7.95) mmHg];尿量[(1.86±0.27)vs.(0.70±0.15) mL·kg-1.h-1];血清乳酸水平[5.1(2.9, 7.4)vs.16.7(12.5, 23.2)mmol/L,P<0.05]。联合机械辅助期间发生急性肾衰竭38.5%,感染35.4%,出血事件14.7%,神经系统并发症11.5%;下肢缺血8.3%。住院死亡患者占60.4%,存活出院患者占39.6%。结论:IABP联合ECMO辅助相关并发症显著增加患者病死风险。护理过程中密切监护,及时进行并发症的预防和护理措施调整,可改善患者预后。

Objective: To summarize the complications and nursing experience of intra-aortic balloon pump(IABP) plus extracorporeal membrane oxygenation(ECMO) after coronary artery bypass grafting(CABG) in patients with coronary heart disease. Methods: The clinical and nursing data of 96 patients with IABP plus ECMO support after CABG were retrospectively analyzed. The changes of physiological indexes, complications and outcomes before and after mechanical support were observed, and the nursing experience was summarized. Results: After mechanical support, the patient′s physiological indexes were significantly improved(Left ventricular effect fraction: [(47.36±5.10)% vs.(29.60±4.52)%];Systolic blood pressure: [(108.20±12.49) vs.(73.88±20.62) mmHg,1 mmHg=0.133 kPa];Diastolic blood pressure: [(61.58±8.14) vs.(38.40±7.95) mmHg];urine volume: [(1.86±0.27) vs.(0.70±0.15) mL·kg-1·h-1];serum lactate level: [5.1(2.9, 7.4)vs. 16.7(12.5, 23.2)mmol/L, P<0.05]. During mechanical support, the occurrence of acute renal failure was 38.5%, infection was 35.4%, bleeding event was 14.7%, neurological complications were 11.46%, and lower limb ischemia was 8.3%. The in-hospital death patients accounted for 60.4%, and the surviving patients accounted for 39.6%. Conclusions: Complications relate-to IABP plus ECMO support significantly increased the risk of death. During the nursing process, close monitoring, timely prevention of complications and adjustment of nursing measures can improve the prognosis of the patients.