22例左心室辅助装置植入患者术后早期管理的单中心经验

Early management after left ventricular assist device implantation in 22 patients: a single center experience

目的探讨和总结单中心22例终末期心力衰竭(ESHF)患者行左心室辅助装置(LVAD)植入术后, 在重症监护室(ICU)期间的早期管理经验。方法回顾性分析2020年9月至2022年8月泰达国际心血管病医院ICU收治的接受LVAD治疗的连续22例ESHF患者临床资料, 其中男16例, 女6例;年龄20~67岁, 平均(51.0±13.3)岁。原发病包括扩张型心肌病21例, 缺血性心肌病1例, 合并重度三尖瓣反流6例, 术前因心源性休克接受主动脉内球囊反搏辅助1例, 因心律失常接受心脏再同步化治疗5例。术后均给予"限制性"液体治疗、"阶梯式"抗凝策略和严格血压管理。回顾术后并发症及治疗过程, 总结治疗和管理经验, 统计分析患者预后情况。结果 22例患者在术后90天内全部生存, 其中21例(95.5%)恢复良好, 血泵运转正常, 无溶血和泵血栓形成。主要并发症包括重症肺炎1例(4.5%), 心包压塞2例(9.1%), 脑出血1例(4.5%), 纵隔感染1例(4.5%), 胃液潜血阳性5例(22.7%);无右心室衰竭、主动脉瓣关闭不全和脑梗塞病例。术后机械通气17(8.5, 51.5)h, 住ICU 14(10, 27)天。结论 LVAD作为ESHF患者除心脏移植外的另一有效治疗手段, 术后早期良好的血压控制、"阶梯式"抗凝策略和"限制性"液体管理有助于减少术后并发症, 改善患者预后。

Objective To investigate and summarize the early management experience of 22 patients with end-stage heart failure(ESHF)who underwent left ventricular assist device(LVAD)implantation in an intensive care unit(ICU)in a single center.Methods Data of 22 patients with ESHF treated with LVAD in the ICU of TEDA International Cardiovascular Hospital from September 2020 to August 2022 were retrospectively analyzed.There were 16 males and 6 females,aged from 20 to 67 years old,with a mean age of(51.0±13.3)years old.There were 21 cases with dilated cardiomyopathy,1 case with ischemic cardiomyopathy,6 cases with tricuspid regurgitation,1 case with intra-aortic balloon pump for cardiogenic shock,and 5 cases with cardiac resynchronization therapy for arrhythmia.After the operation,all patients received restricted fluid therapy,a"stepwise"anticoagulation strategy,and strict blood pressure management.The postoperative complications and treatment process were reviewed,the treatment and management experience were summarized,and the prognosis of the patients was statistically analyzed.Results All 22 patients survived within 90 days after surgery,and 21 patients(95.5%)recovered well,the pump works fine and there was no hemolysis and thrombosis of LVAD.Major complications included:1 case of severe pneumonia(4.5%),2 cases of pericardial tamponade(9.1%),1 case of intracerebral hemorrhage(4.5%),1 case of mediastinal infection(4.5%),5 cases of positive occult blood in gastric juice(22.7%),no cases of right ventricular failure、aortic insufficiency and cerebral infarction.The duration of postoperative mechanical ventilation was 17(8.5,51.5)h,and the ICU stay was 14(10,27)days.Conclusion LVAD is another effective treatment for patients with ESHF in addition to heart transplantation.Good postoperative blood pressure control,"stepwise"anticoagulation strategy and"restrictive"fluid management can reduce postoperative complications in the early phase of post-operation,which is crucial for the prognosis of patients with LVAD.