重症体外循环中主动脉内气囊反搏术的临床估价  

Clinical Evaluation of Intra-Aortic Balloon Pumping in Critical Illed Patients during Extracorporeal Circulation

作　　者：徐新根[1] 殷凤珍[1] 顾伟礼[1] 刁文瑜[1] 钱金兰[1] 邱兆崑[1] 

机构地区：[1]上海市胸科医院心外科,上海200030

出　　处：《生物医学工程与临床》1999年第1期39-43,共5页Biomedical Engineering and Clinical Medicine

摘　　要：我院自1990年1月至1997年8月施行主动脉内气囊反搏术(IABP),救治心脏直视手术泵衰病人共67例,其中男性36例,女性31例,年龄范围16～73岁.心功能(NYHA)Ⅲ级25例,Ⅳ级42例;风湿性心脏病换瓣手术泵衰42例,冠心病搭桥手术后泵衰为22例,先天性心脏病法乐氏四联症纠治术后心脏低排量者为3例.方法:采用Datascope球囊反搏导管,其中17例采用切开皮肤暴露方法,50例采用经皮肤穿刺导管插入股动脉至降主动脉处;以Datascope-83型、95型和97型为驱动装置,严密监测动脉压、左房压或肺毛细血管楔入压,并观察尿排量和血液气体分析情况.结果:经抢救后存活38例,救治成功率为56.7%.在死亡的29例中严重的心律紊乱和顽固性低排量是主要的死亡原因.全组中发生并发症共7例,其中4例为插管例下肢有轻度缺血,2例插管处出现血肿,余下1例为右股动脉血栓形成,经施行取栓术后痊愈.根据应用IABP成功的38例经验,着重强调以下几个方面,当心脏手术后出现:(1)低心排量综合征时,心脏指数<1.8～2.0/L(min·m^3);(2)术中不能脱离体外循环人工心肺机时,或者停机后心脏收缩无力;(3)使用两种以上的大剂量升压药后,循环系统仍不稳定者;(4)心脏发生严重心律紊乱者,应及时地果断地使用IABP,只有这样才能挽救重症体外循环心脏手术后的急性心功能衰竭.The experience of clinical application of intra-aortic balloon pumping (IABP) in 67 patients with acute cardiac failure during extracorporeal circulation from Jan 1990 to Aug 1997 in this hospital was reported. Among these patients there were male 36 and female 31 cases, aged 16 -76 years, body weight between 42-88kg. The cardiac function of these patients was 25 cases in NYHA Ⅲ, 42 cases in NYHA Ⅳ. All of the patients suffered from complicated heart valve disorder and performed operations including initral valve replacement for 42 cases, coronary artery bypass graft for 22 cases and reconstructive operation for Fallot's fetralogy 3 cases.The IABP catheters Datascope-83, Datascope-95 and Datascope-97 were used in these cases. The catheters were inserted by surgical cut via artificial blood vessel into the patient's artery in 17 cases and percutaneously punetuation in the other 50 cases. Thirty-eight patients survived after treatment, the survival rate was 56.7% in these patients. It is emphasised that the application of IABP is an effective method in treating acute pump faillure in patients when low cardiac output syndrome occurs after open heart surgery or in patients who are difficult for weaning from car-diopulmonary bypass. Application of IABP time is important to increase the success rate of treatment.

关 键 词：体外循环 急性心功能衰竭 主动脉内气囊反搏术 

分 类 号：R654.1[医药卫生—外科学]