主动脉内球囊反搏在低射血分数患者非体外循环冠状动脉旁路移植术中应用的必要性探讨  

The role of intraaortic balloon pumping in off-pump coronary artery bypass grafting in patients with a low ejection fraction

作　　者：凌云鹏[1] 陈彧[1] 陈生龙[1] 江龙[1] 沈冬焱[1] 万峰[1] 

机构地区：[1]北京大学人民医院冠心病微创外科中心,北京100044

出　　处：《中国微创外科杂志》2005年第3期223-225,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨对低射血分数患者施行非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting, OPCAB)预防性应用主动脉内球囊反搏(intraaortic balloon pump, IABP)辅助的必要性. 方法 2001 年1 月～2004年10月对64例低射血分数(LVEF≤40%)施行OPCAB,将64例分为2组:术前或术中预防性应用IABP辅助者列为IABP组,共19例;未应用IABP者列为对照组,共45例. 结果 IABP组与对照组在术后并发症手术死亡、脑血管意外、肾功能衰竭衰血滤、围手术期心肌梗死等方面无显著差异(χ2=0.000,P=1.000).IABP组术后需要延长呼吸机带机时间(超过24 h)的比例显著高于对照组(IABP组8例,对照组3例; χ2=9.429,P=0.002);IABP组术后监护时间延长(超过48 h)的比例显著高于对照组(IABP组14例,对照组19例; χ2=4.110,P=0.043). 结论在无IABP辅助的情况下,为低射血分数患者实施OPCAB手术是可行的.Objective To discuss the necessity of prophylactic intraaortic balloon pumping (IABP) in perioperative support for off-pump coronary artery bypass grafting (OPCAB) in patients with a low ejection fraction. Methods A total of 64 patients with a low ejection fraction (LVEF≤40%) underwent the OPCAB from January 2001 to October 2004. The 64 patients were divided into two groups: with (n=19, IABP Group) or without (n=45, Control Group) pre- or intra- operative support of IABP. Results There were no significant differences between the two groups in incidences of postoperative complications, operative death, cerebrovascular accident, renal failure requiring dialysis, and perioperative myocardial infarction ( χ 2=0 000, P =1 000). The proportion of patients who required a prolonged ventilatory support (>24 h) was significantly higher in the IABP Group (8/19) than in the Control Group (3/45) ( χ 2=9 429, P =0 002). And the proportion of patients who required a prolonged ICU stay (>48 h) in the IABP Group (14/19) was significantly higher than that in the Control Group (19/45) ( χ 2=4 110, P =0 043). Conclusions In the absence of prophylactic IABP, OPCAB can be safely operated on in patients with low ejection fraction.

关 键 词：冠状动脉旁路移植术 非体外循环 射血分数 主动脉内球囊反搏 

分 类 号：R654.2[医药卫生—外科学]