主动脉球囊反搏泵在A型主动脉夹层术后循环衰竭患者中的应用

Application of intra-aortic balloon pumping in patients with circulatory failure after surgery for type A aortic dissection

目的探讨A型主动脉夹层患者术后发生循环衰竭时应用主动脉球囊反搏(IABP)治疗的安全性及有效性。方法选择2018年6月至2020年10月于新疆医科大学第一附属医院收治A型主动脉夹层患者128例,对其中9例术后发生循环衰竭并应用IABP救治的患者临床资料进行回顾性分析,探讨IABP在夹层术后患者中应用的可行性。结果9例患者中8例于术后经超声引导股动脉穿刺置入,1例于术中股动脉切开直视下置入,其中1例撤离IABP后循环功能恶化,再次穿刺置入使用,平均使用时间162 h(3 h~17 d)。5例患者6次应用IABP后血流动力学指标改善明显,4例应用后无明显效果。5例于院内死亡,随访4例存活患者,其中1例病情好转,转外院后因夹层破裂死亡,3例目前健康状况良好。结论A型夹层术后患者在面临危及生命的循环衰竭时应用IABP是可行的,应用时机及患者的选择需谨慎决定,需更大样本量实践验证。

Objective To investigate the safety and efficacy of intra-aortic balloon pumping(IABP)in patients with circulatory failure after surgery for type A aortic dissection.Methods The patients with type A aortic dissection(n=128)were chosen from the First Affiliated Hospital of Xinjiang Medical University from June 2018 to Oct.2020.The clinical materials of 9 patients with circulatory failure after surgery for type A aortic dissection treated with IABP were analyzed retrospectively.The feasibility of IABP applied in patients after the surgery was discussed.Results Among 9 patients,there were 8 with IABP implantation by ultrasound-guided femoral artery puncture,and 1 with IABP implantation under direct vision.There was 1 patient with deteriorated circulatory function after IABP evacuation and with IABP implantation once again.The mean application time of IABP was 162 h(3 h~17 d).The indexes of hemodynamics were significantly improved in 5 patients after IABP application for 6 times and had no significant changes in 4 patients.There were 5 patients died in hospital.Among 4 survived patients,the condition was improved in 1 patient,who died due to aortic dissection rupture after being transferred to another hospital.There were 3 patients in good health till now.Conclusion It is feasible to apply IABP in patients with life-threatening circulatory failure after the surgery for type A aortic dissection.The applied time and patient selection need to be carefully decided,and a larger sample size is needed for practical verification.