主动脉内球囊反搏联合体外膜肺氧合治疗心脏手术后难治性心源性休克的疗效观察  

Observation on efficacy of intra-aortic balloon pumping combined with extracorporeal membrane oxygenation on refractory cardiogenic shock after cardiac surgery

作　　者：程国栋[1] CHENG Guo-dong(Gaozhou People's Hospital,Gaozhou 525200,China)

机构地区：[1]广东省高州市人民医院,525200

出　　处：《中国实用医药》2023年第9期5-8,共4页China Practical Medicine

摘　　要：目的回顾性分析院内心脏手术后难治性心源性休克患者实施主动脉内球囊反搏、体外膜肺氧合联合治疗的效果。方法32例心脏手术后难治性心源性休克患者,通过随机分配法分为对照组及观察组,各16例。对照组实施体外膜肺氧合治疗,观察组实施主动脉内球囊反搏联合体外膜肺氧合治疗。比较两组死亡率、动脉收缩压、动脉舒张压、中心静脉压(CVP)、左室射血分数(LVEF)、体外膜肺氧合辅助时间、重症加强护理病房(ICU)治疗时间、血管活性药物评分(VIS评分)、并发症发生率及血乳酸、血肌酐水平。结果观察组死亡1例(6.25%),对照组死亡2例(12.50%)。两组死亡率比较差异无统计学意义(P>0.05)。观察组动脉收缩压(117.28±13.21)mm Hg(1 mm Hg=0.133 kPa)、动脉舒张压(61.29±7.12)mm Hg、LVEF(42.89±17.83)%高于对照组的(79.99±12.10)mm Hg、(52.19±5.28)mm Hg、(30.03±13.37)%,CVP(8.22±3.27)cm H2O(1 cm H2O=0.098 kPa)低于对照组的(13.92±5.33)cm H2O,差异具有统计学意义(P<0.05)。观察组体外膜肺氧合辅助时间(5.19±1.04)d、ICU治疗时间(9.01±3.89)d短于对照组的(6.84±2.08)、(18.37±6.10)d,VIS评分(19.54±5.56)分低于对照组的(26.32±11.18)分,差异具有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。观察组血乳酸(4.22±0.93)mmol/L、血肌酐(138.93±33.20)μmol/L低于对照组的(7.03±2.10)mmol/L、(181.24±48.39)μmol/L,差异具有统计学意义(P<0.05)。结论对心脏手术后难治性心源性休克患者实施主动脉内球囊反搏、体外膜肺氧合联合治疗措施,能够帮助患者维持临床指标稳定状态,有利于并发症发生率的控制,减少患者重症监护时间。Objective To retrospectively analyze the effect of intra-aortic balloon pumping combined with extracorporeal membrane oxygenation on refractory cardiogenic shock after cardiac surgery.Methods A total of 32 patients with refractory cardiogenic shock after cardiac surgery were randomly assigned into control group and observation group,with 16 cases in each group.The control group was treated with extracorporeal membrane oxygenation,and the observation group was treated with intra-aortic balloon pumping and extracorporeal membrane oxygenation.Both groups were compared in terms of mortality,systolic blood pressure,diastolic blood pressure,central venous pressure(CVP),left ventricular ejection fraction(LVEF),extracorporeal membrane oxygen-assisted time,ICU treatment time,vasoactive-inotropic(VIS)score,incidence of complications,blood lactic acid and blood creatinine levels.Results There were 1 death(6.25%)in the observation group and 2 deaths(12.50%)in the control group There was no statistically significant difference in mortality between the two groups(P>0.05).The observation group had systolic blood pressure of(117.28±13.21)mm Hg(1 mm Hg=0.133 kPa),diastolic blood pressure of(61.29±7.12)mm Hg and LVEF of(42.89±17.83)%,which were higher than those of(79.99±12.10)mm Hg,(52.19±5.28)mm Hg,(30.03±13.37)%in the control group;CVP of(8.22±3.27)cm H2O(1 cm H2O=0.098 kPa)in the observation group was lower than that of(13.92±5.33)cm H2O in the control group;the differences were statistically significant(P<0.05).The extracorporeal membrane oxygen-assisted time of(5.19±1.04)d and ICU treatment time of(9.01±3.89)d in the observation group were shorter than those of(6.84±2.08)and(18.37±6.10)d in the control group;VIS score of(19.54±5.56)points in the observation group was lower than that of(26.32±11.18)points in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in incidence of complications between the two groups(P>0.05).The serum lactic acid o

关 键 词：主动脉内球囊反搏 体外膜肺氧合 心脏手术后难治性心源性休克 

分 类 号：R654.2[医药卫生—外科学] R541.64[医药卫生—临床医学]