主动脉内球囊反搏在心脏外科围术期应用的临床分析

Clinical analysis of the application of intra-aortic balloon pump during the perioperative period of cardiac surgery

目的探讨主动脉内球囊反搏(IABP)在心脏外科围术期应用的效果。方法选取2015年1月至2019年12月于该院围术期使用IABP的患者60例,根据手术方式分为搭桥组(n=26)、室壁瘤组(n=10)、搭桥换瓣组(n=17)和瓣膜组(n=7)。对比分析4组术前基线资料,包括年龄、体重指数(BMI)、性别比、心功能分级及超声指标;术后住院病死率、并发症发生率、呼吸机使用时间、重症监护室(ICU)停留时间、术后住院时间及IABP使用情况等。结果4组患者BMI、男性患者百分比、术前心功能分级、术后严重感染发生率、术后病死率及术后住院时间比较,差异无统计学意义(P>0.05)。搭桥组患者术后急性肾衰竭(3.85%)及气管切管发生率(0)明显降低,术后呼吸机使用时间[18.5(17.0,25.5)h]及ICU停留时间[4.0(3.0,6.0)d]明显缩短。在IABP使用方面,术前植入IABP患者百分比(84.62%)较高,术后血小板减少发生率较低,且IABP使用时间[2.00(1.75,2.00)d]较短,4组比较差异有统计学意义(P<0.05)。结论对于重症冠状动脉粥样硬化性心脏病患者,术前IABP的使用能使患者明显获益。

Objective To explore the effect of intra-aortic balloon pump(IABP)during the perioperative period of cardiac surgery.Methods A total of 60 patients who treated with IABP during the perioperative period of cardiac surgery in this hospital from January 2015 to December 2019 were selected and divided into the off-pump coronary artery graft bypass(OPCAB)group(n=26),the ventricular aneurysm group(n=10),the coronary artery graft bypass with valve replacement group(n=17)and the valve replacement group(n=7),according to the surgical modalities.The baseline data,including age,body mass index(BMI),gender ratio,cardiac function classification and ultrasound indicators,postoperative in-hospital mortality,incidence of complications,application time of respirator,length of intensive care unit(ICU)stay,length of postoperative hospital stay and IABP usage were compared and analyzed among the four groups.Results No statistically significant difference was found in BMI,percentage of male patients,preoperative cardiac function classification,incidence of severe postoperative infection,postoperative in-hospital mortality and length of postoperative hospital stay among the four groups(P>0.05).In the OPCAB group the incidence of postoperative acute kidney injury(3.85%)and rate of tracheotomy(0)were significantly reduced,and the postoperative application time of respirator[18.5(17.0,25.5)h]and length of ICU stay[4.0(3.0,6.0)d]significantly shortened.In terms of the use of IABP,the proportion of patients with IABP implanted before operation(84.62%)was significantly higher,the incidence of postoperative thrombocytopenia was significantly reduced,the use time of IABP[2.00(1.75,2.00)d]was significantly shorter,and there were statistically significant differences among the four groups(P<0.05).Conclusion For patients with severe coronary atherosclerotic heart disease,the application of IABP before operation can significantly benefit the patient.