HeartCon型左心室辅助装置治疗20例成人终末期心衰患者的近期效果观察  

Short-term effect of HeartCon left ventricular assist device on the treatment of 20 adult patients with end-stage heart failure

作　　者：王伟[1] 宋昱[2] 张云强[2] 王正清[3] 刘志刚[3] 李树杰 唐渊 刘晓程[3] Wang Wei;Song Yu;Zhang Yunqiang;Wang Zhengqing;Liu Zhigang;Li Shujie;Tang Yuan;Liu Xiaocheng(Intensive Care Unit,Teda International Cardiovascular Hospital,Tianjin 300457,China;Department of Cardiac Care Unit,Teda International Cardiovascular Hospital,Tianjin 300457,China;Department of Cardiac Surgery,Teda International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院ICU,天津300457 [2]泰达国际心血管病医院心内科CCU,天津300457 [3]泰达国际心血管病医院心外科,天津300457

出　　处：《中华危重病急救医学》2022年第12期1258-1262,共5页Chinese Critical Care Medicine

基　　金：国家重点研发计划(2017YFC0111005);天津市医学重点学科(专科)建设项目(TJYXZDXK-019A)。

摘　　要：目的探讨和评价HeartCon型左心室辅助装置(LVAD)用于终末期心力衰竭(ESHF)患者的治疗效果和安全性。方法采用前瞻性和观察性研究方法,选择2020年9月至2021年8月在泰达国际心血管病医院心外科行LVAD植入手术的ESHF患者为研究对象。观察患者LVAD植入术前及术后90 d左室舒张期末内径(LVEDD)、左室射血分数(LVEF)、美国纽约心脏病学会(NYHA)分级、N末端脑钠肽前体(NT-proBNP)、6 min步行距离(6MWD)变化;记录术后90 d内设备故障发生率和主要不良事件的发生情况。结果共纳入20例ESHF患者,其中男性15例,女性5例;年龄20~67岁,平均(50.2±13.6)岁;体质量49.8~106.1 kg,平均(67.9±15.5)kg;体表面积(BSA)1.49~2.32 m2,平均(1.76±0.22)m2。所有患者手术过程均顺利,住院时间33~90 d,平均56.0(42.8,75.0)d。LVAD植入术后90 d内主要并发症包括心包填塞2例(10%)、脑出血1例(5%)、纵隔感染1例(5%)、急性肾损伤(AKI)3例(15%)、胃液潜血阳性5例(25%);无血泵机械故障及溶血事件发生,无右心室衰竭(RVF)、脑梗死及死亡病例。与LVAD植入术前比较,术后90 d患者LVEDD明显缩小(mm:67.50±13.98比77.40±9.73),LVEF明显增加(%:34.80±9.76比22.70±5.62),NT-proBNP明显降低(ng/L:2?028.65±1?752.05比4?796.45±4?355.40),6MWD明显增加(m:385.20±144.12比85.81±63.50),差异均有统计学意义(均P<0.05)。20例患者中,18例(90%)达到NYHA分级Ⅰ级,2例(10%)达到Ⅱ级,均较术前明显改善(术前患者均为Ⅳ级)。结论HeartCon型LVAD能有效改善ESHF患者生活质量,且临床试验证实其安全有效,但其长期效果和并发症等尚需进一步观察和深入研究。Objective To investigate and evaluate the efficacy of HeartCon left ventricular assist device(LVAD)in the treatment of adult patients with end-stage heart failure(ESHF).Methods A prospective and observational study was conducted.Patients with ESHF who underwent LVAD implantation in the department of cardiac surgery of Teda International Cardiovascular Hospital from September 2020 to August 2021 were selected.The left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),New York Heart Association(NYHA)classification,N-terminal pro-B type natriuretic peptide(NT-proBNP),and six minute walk distance(6MWD)before operation and 90 days after operation were compared.The incidence of equipment failures and major adverse events within 90 days after operation were recorded.Results A total of 20 patients with ESHF were included,with 15 males and 5 females.Patients'age ranged from 20 to 67 years old,with an average of(50.2±13.6)years old.The range of body weight was 49.8-106.1 kg,with an average of(67.9±15.5)kg,and the body surface area(BSA)was from 1.49 to 2.32 m2,with an average of(17.6±0.22)m2.The operation process of all the patients were successful.The length of hospital stay ranged from 33 to 90 days,and the average was 56.0(42.8,75.0)days.Complications within 90 days after operation as follows,2 cases with pericardial tamponade(10%),1 case with cerebral hemorrhage(5%),1 case with mediastinum infection(5%),3 cases with acute renal injury(AKI,15%),5 cases with gastrointestinal bleeding(25%).There were no mechanical failure of LVAD and hemolysis events,right ventricular failure(RVF),cerebral infarction and death occurred.Compared with preoperative,the LVEDD significantly decreased(mm:67.50±13.98 vs.77.40±9.73),LVEF significantly increased(%:34.80±9.76 vs.22.70±5.62),NT-proBNP significantly decreased(ng/L:2028.65±1752.05 vs.4796.45±4355.40),6MWD significantly increased(m:385.20±144.12 vs.85.81±63.50)at 90 days after operation,and the differences were statistically significant(all P<

关 键 词：左心室辅助装置 成人 终末期心力衰竭 效果 

分 类 号：R654.2[医药卫生—外科学]