左心辅助装置在小儿先天性心脏病术后的短期应用  

Short term left ventricular assistive device use in postoperative pediatric patients with congenital heart disease

作　　者：张蔚[1] 杨寅愉 张海波[1] 郑景浩[1] 王伟[1] Zhang Wei;Yang Yinyu;Zhang Haibo;Zheng Jinghao;Wang Wei(Shanghai Children＇ s Medical Center Department of Cardiothoracic Surgery,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2018年第7期398-402,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨和总结左心室辅助装置（LVAD）在小儿先天性心脏病（先心病）术后短期辅助的临床经验及方法。方法回顾2011年1月至2016年4月施行的先心病手术中出现无法脱离体外循环或术后短期在监护室出现单纯左心衰竭，予以大剂量强心药物无法维持血流动力学稳定，床边超声心动图提示左心室收缩乏力，估测左心室射血分数〈0．2，使用MaquetRotaflow离心泵进行短期LVAD辅助的患儿共17例，对其临床资料及数据进行比较、分析和评价。结果17例患儿根据出院时是否死亡分为：早期死亡组（6例）、生存组（11例）。生存组左心室辅助前时间[（9．00±9．95）h对（23．83±13．23）h，P=0．042]、乳酸水平[（4．01±2．15）mmot／L对（9．30±4．90）mmol／L，P=0．045]小于早期死亡组，而左心室辅助时间明显高于死亡组[（77．00±23．58）h对（34．00±19．80）h，P=0．002]。结论使用Maquet Rotaflow离心泵进行左心室辅助是安全有效的，患者的选择、安装的时机以及合理的辅助管理是成功的关键。Objective To discuss the methods and experience of using short term left ventricular assist devices （LVADs） in patients after congenital heart disease（CHD） corrective surgery. Methods This study included 17 postoperative cases using short term LVAD support. The device used was a Maquet Rotaflow system, and the clinical patient data was collected and eval- uated retrospectively. Results The 17 patients were divided into two groups by the clinical outcome as follows： 6 cases in the early death group（ Group D） and 11 cases in the survival group （Group S）. The pre-support time [ （9. 00 ± 9.95）h vs. （23.83 ± 13.23 ） h, P = 0. 042 ] and the lactate level values[ （4.01 ± 2.15 ） mmol/L vs. （9.30 ± 4.90） mmol/L, P = 0. 045 ] were significantly lower and more favorable in Group S. Patients in Group S also received a longer support time than patients in Group D. Conclusion Using the Maquet Rotaflow system is generally safe and efficient, when used as a short term LVAD in postoperative pediatric patients. The selection of patients, the timing of support, and reasonable management were the keys to patient survival.

关 键 词：先天性心脏病 左心衰竭 左心室辅助 

分 类 号：R726.5[医药卫生—儿科]