IABP在重症心脏瓣膜置换术的应用  

The application of intra-aortic balloon pump in treatment of severe valvular heart disease after cardiac valve replacement

作　　者：胡寿祥 方填源 赖及隆 曾明 

机构地区：[1] 茂名市中医院心胸外科,广东省茂名市525000 [2] 茂名市中医院心血管内科,广东省茂名市525000 [3] 茂名市中医院ICU,广东省茂名市525000

出　　处：《中国心血管病研究》2016年第7期620-622,共3页Chinese Journal of Cardiovascular Research

基　　金：广东省茂名市科技局2012年立项项目（项目编号：20120331）

摘　　要：目的 总结主动脉内球囊反搏泵（IABP）在重症心脏瓣膜置换术后的应用经验.方法 回顾分析茂名市中医院心胸外科近10年来应用1ABP治疗重症心脏瓣膜置换术后出现的低心排出量综合征患者9例,其中男性7例、女性2例,年龄45～71（55.20±9.60）岁,术前诊断为风湿性心脏瓣膜病.其中冠脉造影明确合并冠心病1例,术前心脏超声检查巨大左心房4例,左心房血栓2例,三尖瓣重度关闭不全并中重度肺动脉高压8例;心功能NYHA分级Ⅲ级2例、Ⅳ级7例.行二尖瓣置换＋左房折叠＋三尖瓣成形2例,二尖瓣置换＋三尖瓣成形3例,主动脉瓣置换1例,二尖瓣＋主动脉瓣置换＋三尖瓣成形2例,冠状动脉旁路移植术＋二尖瓣置换＋三尖瓣成形1例.比较IABP使用前、后心率（HR）,有创平均压（MABP）,中心静脉压（CVP）,动脉氧分压（PaO2）,乳酸（Lac）,尿量和肾上腺素用量.结果 全组患者行IABP辅助治疗时间48～196（64.2±25.6）h.使用IABP后,HR、MABP、CVP、PaO2、Lac、尿量及肾上腺素用量与使用前有明显差异（P＜0.05）.本组存活5例,死亡4例,死亡原因分别为低心排出量综合征（2例）、多脏器衰竭（2例）,无IABP相关并发症.结论 IABP是成功抢救重症心脏瓣膜置换术后低心排的有效措施,及时应用IABP可以提高手术的成功率.Objective To summarize the experience of the application of intra-aortic balloon pump （Ⅰ- ABP） in patients with severe valvular heart disease after cardiac valve replacement. Methods 9 patients with se- vere valvular heart disease were treated by IABP when low cardiac output syndrome （LCOS） occurred after cardiac valve replacement in recent 10 years in Maoming hospital of traditional Chinese medicine. There were 7 males and 2 females. Their age ranged from 45 to 71 years, mean age （55.20±9.60）years. All patients were diagnosed rheumatic heart valve disease before operation and 1 patient with coronary heart disease by coronary angiography and by echocardiography, 4 with giant left atrium, 2 with left atrial thrombus, 8 with tricuspid regurgitation, and pulmonary hypertension. There were 2 patients in class Ⅲ and 7 patients were class Ⅳ of New York heart associa- tion （NYHA） heart function classification. In these patients, 2 cases were undergone mitral valve replacement and tricuspid valvuloplasty and left atrium placation, 3 mitral valve replacement and tricuspid valvuloplasty, 1 aortic valve replacement, 2 aortic and mitral valve replacement and tricuspid valvuloplasty, 1 mitral valve replacement and tricuspid valve valvuloplasty and coronary artery bypass graft. It was compared with heart rate （HR）, invasive mean arterial blood pressure （MABP）, central venous pressure （CVP）, arterial partial pressure of oxygen（PaO2）, lactate（Lac）, urine, and the dosage of adrenaline before and after IABP. Results The IABP support time ranged from 48 to 196 （64.2±25.6）hours. It showed significant difference of HR, MABP, CVP, PaO2, Lac, urine, and the dosage of adrenaline before and after IABP （P〈0.05）. 5 cases survived and 4 cases died, the cause of death were respectively LOCS（2 cases）, multiple organ failure（2 cases）. There were no complications associated with IABP. Conclusion IABP can be effective in improving the surgery outcome in patients with severe valvular h

关 键 词：重症心脏瓣膜病 主动脉内球囊反搏 瓣膜置换术 低心排量综合征 

分 类 号：R654.2[医药卫生—外科学]