摘要
目的：回顾分析主动脉内球囊反搏在心脏外科围术期使用的适应证选择与效果。方法：2004年6月至2007年8月，对38例心脏外科手术患者实施了主动脉内球囊反搏术，其中冠心病28例，瓣膜病10例；术中预防性植入球囊反搏5例，因为无法停机植入球囊22例，其余均为术后在监护室紧急植入。均采用低分子肝素抗凝，控制激活全血凝固时间（activated clotting time，ACT）150～170s。结果：38例患者中死亡13例，总成功率66％，冠心病成功率82％，瓣膜病为20％。术中预防性植入球囊反搏患者均顺利恢复，无1例死亡；术中因为无法停机植入的患者中16例顺利停机，6例血压无法维持而死亡；术后ll例中，6例抢救成功，5例因低心排综合征无法纠正而死亡。无1例出现与球囊反搏相关的严重并发症。结论：主动脉内球囊反搏对于冠心病患者效果明显优于瓣膜病。术中预防性植入球囊反搏的效果明显优于无法停机时紧急植入以及术后使用。低分子肝素抗凝可以替代常规肝素抗凝，ACT控制在较低的150～170s比较合适。
Objective To review the indications and effect of the intra-aortic balloon pump （IABP） in 38 patients during the cardiac surgery. Methods From June 2004 to August 2007, 38 patients were performed IABP in the cardiac surgery, including 28 coronary artery bypass grafting （ CABG ） and 10 valve replacements. The intra-operation prophylactic use of IABP was in 5 cases, the use of IABP for weaning from cardiopulmonary bypass （ CPB ） during the cardiac surgery was in 22 cases, and the rest use of IABP was after the operation in the intensive care unit. Low molecular weight heparin was used for IABP anticoagulation. Results Thirteen died out of the 38 IABP patients. The total IABP success rate was 66%. The IABP success rate in CABG was 82% , and 20% in the valve replacement. The patients with intra-operation prophylactic use of IABP all recovered, and 16 recovered out of the 22 patients with IABP uses for weaning from CPB, and 6 recovered out of the 11 patients with post-operation IABP application. No severe complications related to IABP occurred. Conclusion IABP has better effect in CABG patients than in valve replacements. Effect of the prophylactic use of IABP is better than both the IABP use for weaning from CPB or the post-operation IABP application. For IABP anticoagulation, low molecular weight heparin is the better alternative than routine heparin, and the proper ACT is controlled at 150-170s.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2008年第3期262-265,共4页
Journal of Central South University ：Medical Science
关键词
主动脉内球囊反搏
低心排综合征
心内直视术
intra-aortic balloon counter-pulsation
low cardiac output syndrome
cardiac surgery
