左心室辅助装置植入患者围手术期的临床特征及预后分析  

Clinical characteristics and prognosis of patients with left ventricular assist device implantation during perioperative period

作　　者：杨聿航 聂帅[1] 宋三兵 沈骁 章淬[1] 宋晓春[1] Yang Yuhang;Nie Shuai;Song Sanbing;Shen Xiao;Zhang Cui;Song Xiaochun(Department of Critical Care Medicine,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院重症医学科,南京210006

出　　处：《中华胸心血管外科杂志》2024年第1期1-6,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨左心室辅助装置(left ventricular assist device,LVAD)植入患者围手术期的临床特征及预后情况。方法回顾性纳入2022年2月至2023年3月期间就诊南京医科大学附属南京医院重症医学科(ICU)行LVAD植入术的终末期心力衰竭患者14例,其中男12例,女2例;年龄37~75岁,平均(57.6±9.8)岁。入组患者均植入Corheart 6植入式左心室辅助系统,未使用其他机械辅助循环装置。收集患者临床资料,分析其入ICU治疗期间的临床特征及预后转归。结果本组患者心力衰竭由扩张型心肌病导致12例,由终末期缺血性心肌病所致2例。经胸超声心动图结果显示,植入LVAD后,患者的左心室射血分数(0.297±0.074对0.238±0.064,P=0.031)较术前显著增加,左心室舒张末期内径[69.0(65.8,74.3)mm对76.5(72.8,83.0)mm,P=0.003]和收缩末期内径[61.5(53.7,65.3)mm对68.3(63.8,71.9)mm,P=0.005]较术前均显著减小。术后第1、3、7天的LVAD转速、流量及脉动指数差异无统计学意义(P>0.05)。入ICU治疗期间,多巴酚丁胺(13例)是最常用的血管活性药物。针对围手术期肺动脉高压,9例患者应用磷酸二酯酶Ⅲ型抑制剂治疗。为更好地防治术后并发右心功能衰竭、减轻右心前后负荷,对入组患者进行容量及压力指标的目标性管理:术后72 h内,监测患者的平均肺动脉压为24(22,26)mmHg至26(21,28)mmHg(1 mmHg=0.133 kPa),液体平衡为(-581±778)ml至(-1209±1134)ml。入组患者均生存至术后28天,机械通气8(5,28)h,住ICU(8.0±1.8)天,住院33(29,41)天。结论LVAD植入有助于改善终末期心力衰竭患者的左心室收缩功能,延长生存时间,可以作为终末治疗或桥接心脏移植的重要手段。加强对LVAD植入患者围手术期的血流动力学调控及心功能维护,是ICU术后管理的重要目的之一。Objective To investigate the clinical characteristics and prognosis of patients with left ventricular assist device(LVAD)implantation during the perioperative period.Methods This retrospective study included 14 patients with end-stage heart failure who underwent LVAD implantation in the department of intensive care medicine of Nanjing Hospital Affiliated to Nanjing Medical University from February 2022 to March 2023,including 12 males and 2 females patients,the mean age was(57.6±9.8)years old.All patients were implanted with Corheart 6 implantable left ventricular assist system,did not use other mechanical assisted circulatory devices.The clinical data of enrolled patients were collected,and the clinical characteristics and prognosis during ICU treatment were analyzed.Results Dilated cardiomyopathy(DCM)was the most common primary cause of heart failure.The results of transthoracic echocardiography showed that the left ventricular ejection fraction(0.297±0.074 vs.0.238±0.064,P=0.031)of patients was significantly increased,while the left ventricular end diastolic diameter[69.0(65.8,74.3)mm vs.76.5(72.8,83.0)mm,P=0.003]and systolic end systolic diameter[61.5(53.7,65.3)mm vs.68.3(63.8,71.9)mm,P=0.005]were significantly decreased post LVAD implantation as compared to before LVAD implantation.Within one week after implantation,there was no significant difference in LVAD rotational speed,flow rate,and pulsation index(P>0.05).During ICU treatment,dobutamine(13 cases)was the most commonly used vasoactive agent.9 patients used phosphodiesteraseⅢinhibitors for perioperative pulmonary hypertension.Targeted management of volume and pressure indicators was conducted for enrolled patients to prevent postoperative right heart failure and to reduce right heart burden.Within 72 hours after LVAD implantation,the average pulmonary artery pressure of patients was 24(22,26)mmHg to 26(21,28)mmHg(1 mmHg=0.133 kPa),while the fluid balance was(-581±778)ml to(-1209±1134)ml.All enrolled patients survived to 28 days after LVAD implant

关 键 词：心室辅助装置 心力衰竭 临床特征 预后 

分 类 号：R541.6[医药卫生—心血管疾病]