机械辅助循环在心脏围术期严重低心排综合征中的临床应用  

Clinical application of mechanical circulatory support to perioperative low cardiac output syndrome in cardiac surgery

作　　者：邱志兵[1] 陈鑫[1] 肖立琼[1] 徐明[1] 蒋英硕[1] 汪黎明[1] 张扬波[1] 杨婷[1] 

机构地区：[1]南京医科大学附属南京第一医院南京市心血管病医院心血管外科,210006

出　　处：《中国急救医学》2009年第7期608-611,共4页Chinese Journal of Critical Care Medicine

基　　金：基金项目：江苏省社会发展基金资助项目（No.20064063）

摘　　要：目的 探讨机械辅助循环在心脏外科围术期严重低心排出量综合征中的治疗效果，总结临床经验。方法自2002—02—2009—02对66例心脏外科围术期低心排综合征患者应用主动脉内球囊反搏（IABP）、离心泵和体外膜肺氧合（ECMO）支持治疗，总结临床资料，观察辅助循环前后血流动力学和超声心动图的变化。结果59例患者置入IABP治疗，其中29例术中置入，30例术后置入；应用ECMO治疗6例，离心泵治疗1例。所有患者均顺利脱离机械辅助循环。机械辅助循环后患者血流动力学明显改善，正性肌力药物用量也显著减少，且扩张的心脏缩小，收缩力加强。结论机械辅助循环是一种重要的体外生命支持形式，对终末期心脏外科围术期严重低心排综合征提供有效的支持治疗，提倡积极、早期、合理和有选择性地应用。Objective To sum up the clinical experience of mechanical circulatory support in the treatment of perioperative low cardiac output syndrome in cardiac surgery. Methods From February 2002 to February 2009, 66 patients received mechanical circulatory support including intra - aortic balloon pump（ IABP） , centrifugal pump, extracorporeal membrane oxygenation （ECMO）. We retrospectively studied the clinical materials, the changes of hemodynamics and echocardiography. Results IABP were used in 59 patients including 29 cases inserted intraoperatively and 32 cases inserted postoperatively. Six patients were supported by ECMO and one patient by centrifugal pump. All the patients were successfully weaned from mechanical circulatory support. After mechanical circulatory support, the hemodynamics was improved obviously, and the amount of using inotropic drug significantly reduced. Moreover, the diameter of dilated heart was significantly decreased and the contractility became stronger. Conclusion Mechanical circulatory support is an important extracorporeal method to support life, which is an effective treatment for perioperative low cardiac output syndrome in cardiac surgery and should he used early, properly and selectively.

关 键 词：机械辅助循环 低心排出量综合征 主动脉内球囊反搏(IABP) 体外膜肺氧合(ECMO) 离心泵 

分 类 号：R595.1[医药卫生—内科学]