床旁开胸紧急体外循环术抢救心脏外科术后恶性心律失常  

Bedside thoracotomy emergency cardiopulmonary bypass in salvage of malignant arrhythmia after cardiac surgery

作　　者：李岩[1] 常谦[1] 钱向阳[1] 孙晓刚[1] 张海涛[1] 杨戎[1] 

机构地区：[1]中国医学科学院阜外心血管病医院心血管外科,100037

出　　处：《中国现代药物应用》2015年第13期18-19,共2页Chinese Journal of Modern Drug Application

摘　　要：目的探讨床旁开胸紧急体外循环术(ECPB)抢救心脏外科术后顽固性恶性心律失常的效果。方法回顾性分析58例因心脏术后顽固性恶性心律失常而接受床旁紧急体外循环术抢救的患者的临床资料,总结其特点、危险因素和预后。结果复杂先天性心脏病矫治术和冠状动脉旁路移植术是出现恶性心律失常的两种主要术式;术后10 min^18 h是恶性心律失常发生的主要时间段;冠脉缺血事件和术后低心排综合征是导致术后恶性心律失常的两个常见原因。全组患者抢救成功率96.6%,高龄、低体重和延缓的体外循环建立时间是围术期死亡的独立危险因素。结论床旁开胸紧急体外循环术是抢救心脏外科术后顽固性恶性心律失常的安全有效方法 ,值得临床推广应用。Objective To investigate the effect of bedside thoracotomy emergency cardiopulmonary bypass （ECPB） in rescue of refractory malignant arrhythmia after cardiac surgery. Methods Clinical data of 58 patients with refractory malignant arrhythmia after cardiac surgery, who receiving bedside thoracotomy emergency cardiopulmonary bypass, were retrospectively analyzed. Their characteristics, risk factors and prognosis were summarized. Results Complex congenital heart disease surgery and coronary artery bypass grafting were the two main operations that led to malignant arrhythmia. The main occurrence time of malignant arrhythmia was postoperative 10-18 min. Coronary ischemic events and postoperative low cardiac output syndrome were the two main causes of postoperative malignant arrhythmia. The success rate of rescue for all the patients was 96.6%. Independent risk factors for perioperative death included advanced age, low weight and slow setup time of extracorporeal circulation. Conclusion Bedside thoracotomy emergency cardiopulmonary bypass is a safe and effective method for rescuing refractory malignant arrhythmia after cardiac surgery, and this method is worthy of clinical promotion and application.

关 键 词：心脏手术 恶性心律失常 紧急体外循环 床旁 

分 类 号：R654.2[医药卫生—外科学]