辅助循环在心脏直视手术后心搏骤停中的应用  

The application of various combination of assisted circulation devices in cardiopulmonary cerebral resuscitation

作　　者：黄焕雷[1] 肖学钧[1] 吴若彬[1] 章晓华[1] 范瑞新[1] 成安衡[1] 罗征祥[1] 

机构地区：[1]广东省人民医院,广东省心血管病研究所外科,广东省广州510100

出　　处：《中华急诊医学杂志》2005年第5期373-376,共4页Chinese Journal of Emergency Medicine

基　　金：国家"二十五"攻关项目(2001AB706B06)

摘　　要：目的通过回顾性研究,探讨多种辅助循环装置的联合应用在经常规心肺脑复苏方法抢救后无效的心搏骤停患者中的使用效果。方法在心脏直视手术后早期(82min～56h)发生心搏骤停,经常规方法行心肺脑复苏达20min以上,而未能恢复有效自主循环的16例成人患者中,单独使用急诊体外循环(ECPB)2例,联合应用急诊体外循环与主动脉内球囊反搏(IABP)8例,急诊体外循环与主动脉内球囊反搏和左心辅助(LVAD)三者联合应用6例。结果1例患者顺利停机,1例患者死亡。其余14例患者中,13例恢复自主心律,1例反复出现室性心律,均不能撤离体外循环。联合应用IABP和LVAD后,有6例成功撤离辅助循环。复苏成功共7例(43.8%):1例患者于撤离辅助循环装置后第11天再发心搏骤停,经抢救无效死亡;另6例痊愈出院。随访3～49个月,1例因在使用LVAD过程中并发脑栓塞后遗右侧肢体轻度活动受限,其余5例未出现中枢神经系统并发症。无远期死亡,生存率37.5%(616)。结论急诊体外循环可迅速有效地恢复血流灌注和供氧,纠正酸中毒,改善内环境;主动脉内球囊反搏和左心辅助与急诊体外循环的联合应用,可缩短体外循环的时间,提高撤机率和复苏成功率。经常规心肺脑复苏无效的心搏骤停患者,及时采用辅助循环装置是一种行之有效的方法。Objective To evaluate various combination of assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral resuscitation (CPCR).Methods Assisted circulation devices, including emergency cardiopulmonary bypass (ECPB), intra arotic balloon pump (IABP), and left ventricular assist device (LVAD), were applied to 16 adult patients who had cardiac arrest 82 minutes to 56 hours after open heart surgery and did not respond to 20 minutes or longer conventional CPCR. ECPB was applied to 2 patients, ECPB plus IABP to 8 patients, ECPB plus IABP and LVAD to 6 patients. Results One patient recovered and one patient died. Among another 14 patients, 13 resumed spontaneous cardiac rhythm and one did not, but no one could be weaned from ECPB. The combination of IABP and LVAD enabled 6 patients to wean from ECPB. Among the 7 patients with successful resuscitation, one died of reoccurring cardiac arrest after 11 days, and another 6 were discharged and were followed up for 3 to 49 months (mean =22 months). Of the 6 discharged patients, one suffered cerebral embolism during LVAD treatment, resulting in mild limitation of mobility of the right limbs; another 5 didn't manifest any central nervous system complications. There was no late deaths giving a 37.5% (6/16) long-term survival rate. Conclusion ECPB could effectively reestablish blood circulation and oxygen supply, rectify acidosis, and improve internal milieu. The combined application of ECPB, IABP, and LVAD reduces the duration of ECPB, improves the incidence of recovery, and offers beneficial alternatives to refractory cardiac arrest patients.

关 键 词：心搏骤停 心脏直视 主动脉内球囊反搏 急诊体外循环 手术后 辅助循环装置 中枢神经系统并发症 左心辅助 LVAD 回顾性研究 复苏成功率 心肺脑复苏 使用效果 复苏方法 术后早期 常规方法 成人患者 自主循环 自主心律 室性心律 

分 类 号：R654.2[医药卫生—外科学]