心脏外科围术期主动脉内球囊反搏应用及其并发症的临床分析  

Clinical analysis of perioperative application and complications of Intra-aortic Balloon Pump in cardiac surgery

作　　者：杨海平[1] 郝懿[1] 陈林[1] 张振华[1] 孙林[1] 吴骏[1] 王立杰[1] 李卫强[1] 王艳喻 张建鹏[1] 

机构地区：[1]首都医科大学附属北京潞河医院胸心外科,101100

出　　处：《中国综合临床》2017年第3期217-221,共5页Clinical Medicine of China

摘　　要：目的 对心脏手术围术期患者置入主动脉球囊反搏（IABP）的疗效及并发症进行总结分析. 方法 回顾分析2011年1月至2016年9月我院心脏手术围术期置入IABP患者36例,其中冠心病27例,瓣膜病8例,左房粘液瘤1例.收集患者临床资料,并对其治疗效果及并发症情况进行分析总结.结果 全组死亡10例（27.8%）,置入IABP冠心病患者病死率低于非冠心病患者（18.5% 与 55.6%,χ^2=4.615,P=0.032）.置入IABP后相关并发症包括：血小板减少6例（16.7%）、下肢缺血3例（8.3%）、下肢动脉血栓栓塞2例（5.6%）、股动脉假性动脉瘤2例（5.6%）、急性胰腺炎2例（5.6%）、肠系膜缺血肠坏死1例（2.8%）、消化道出血2例（5.6%）、穿刺处出血3例（8.3%）、发热4例（11.1%）、管路漏气1例（2.8%）、管腔无压力数据1例（2.8%）.26例存活患者应用IABP治疗后,患者血流动力学指标（平均动脉压、心率、中心静脉压、尿量）较治疗前明显改善、多巴胺和肾上腺素用量减少（t值分别为-22.35、64.41、53.31、-23.82、26.07、14.15,P均〈0.05）.结论 IABP能明显提高心脏手术围术期的治疗效果,积极处理并发症减少IABP引发的死亡.Objective To assess the perioperative efficacy and complications of intra-aortic balloon pump（IABP） in patients with cardiac operation.Methods A total of 36 cases with IABP patients from January 2011 to September 2016 were studied in Luhe Hospital of Beijing Affiliated to Capital Medical University,inluding 27 patients with coronary atherosclerotic heart disease（CAD）,8 patients with valvular heart diseaseand and 1 patient with left atrial myxoma.The clinical data was collected to analyze IABP efficacy and complications.Results There were 10（27.8%） patients died,the mortality rate of CAD patients was lower than that of non-CAD patients（18.5% vs.55.6%,X2=4.615,P=0.032）.The related complications after IABP implantation included：6（16.7%） cases suffered from thrombocytopenia,3（8.3%） cases with lower limb ischemia,2（5.6%） cases with lower extremity arterial thromboembolism,2（5.6%） cases with femoral artery pseudoaneurysm,2（5.6%） cases with acute pancreatitis,1（2.8%） cases with intestinal necrosis by mesenteric ischemia,2（5.6%） cases with gastrointestinal bleeding,3（8.3%） cases with hemorrhage in puncture site,4（11.1%） cases of fever,1（2.8%） case with pipeline leak,and 1（2.8%） case no pressure lumen data.After treatment with IABP,in 26 cases survival patients,the hemodynamic indexes（mean arterial pressure,heart rate,central venous pressure,urine volume） were significantly improved and the amount of dopamine and epinephrine decreased（t=-22.35,64.41,53.31,-23.82,26.07,14.15 respectively,P〈0.05）.Conclusion IABP can significantly improve the perioperative efficacy.The active treatment on complications is important to reduce the death induced by IABP.

关 键 词：主动脉内球囊反搏 心脏手术围术期 并发症 

分 类 号：R654.2[医药卫生—外科学]