Clinical application of intra-aortic balloon pump in perioperative period of coronary arnery bypass grafting
-
摘要: 目的：对冠状动脉（冠脉）搭桥手术围术期患者的主动脉内球囊反搏（IABP）的使用情况及其并发症进行总结分析。方法：回顾分析我院心胸外科2014-01-2017-12于围术期置入IABP的冠脉搭桥患者共47例，收集患者临床资料，总结分析其临床使用情况及其并发症。结果：47例患者IABP平均置入时间（7.46±4.99） d。置入IABP后，患者心功能及血流动力学均有所改善。并发症发生率48.94%，相关并发症包括：血小板减少17例（36.17%），其中严重血小板减少8例（17.02%），肠梗阻7例（14.89%），肠系膜动脉栓塞并发肠穿孔2例（0.04%），下肢动脉栓塞1例（0.02%），下肢缺血3例（0.06%），消化道出血1例（0.02%），穿刺部位假性动脉瘤1例（0.02%），弥散性血管内凝血（DIC）4例（0.09%）。死亡8例，病死率17.02%，其中3例死于心功能差、持续低心排；2例肠穿孔、感染性休克；1例肝衰竭、DIC；1例脑出血；1例肾衰竭、高钾血症。结论：IABP是冠脉搭桥手术围术期改善心功能的有效辅助办法。并发症发生率较高，其中血小板减少是最常见的并发症。早期拔除是减少并发症的最有效办法。Abstract: Objective: To summarize the use of intra-aortic balloon pump (IABP) and its complications during perioperative coronary artery bypass surgery.Method: A retrospective analysis of our hospital from January 2014 to December 2017 in our department of cardiothoracic surgery in IABP perioperative was placed in patients with coronary artery bypass grafting.The clinical data were collected to summarize its clinical use and complications.Result: The average IABP placement time of 47 patients was 7.46±3.99 days.After IABP was inserted, the patient's cardiac function and hemodynamics were improved.The incidence of their complications was 48.94%.Complications included thrombocytopenia in 17 cases (36.17%), severe thrombocytopenia in 8 cases (17.02%), intestinal obstruction in 7 cases (14.89%), mesenteric arterial embolism in 2 cases (0.02%), lower extremity arterial embolism in 1 case (0.02%), lower extremity ischemia in 3 cases (0.06%), gastrointestinal bleeding in 1 case (0.09%).Eight patients died, with a mortality rate of 17.02%.Three patients died of poor cardiac function and sustained low cardiac output.Two patients had intestinal perforation and septic shock, one liver failure and DIC, one cerebral hemorrhage, and one renal failure and Kakamosis.Conclusion: IABP is an effective adjuvant to improve cardiac function in patients undergoing coronary bypass surgery.The incidence of complications is high, with thrombocytopenia being the most common complication.Early removal is the most effective way to reduce complications.
-
-
[1] 胡方斌, 赵杰, 聂亚彬, 等.床旁紧急主动脉内球囊反搏术的临床应用[J].临床心血管病杂志, 2014, 30(2):120-123.
[2] Kantrowitz A, Wasfie T, Freed PS, et al.Intra-aortic balloon pumping 1967 through 1982:analysis of complications in 733 patients[J].Am J Cardiol, 1986, 57(11):976-983.
[3] 潘宏伟, 郭莹, 郑昭芬, 等.急性心肌梗死并休克不同时机应用主动脉内球囊反搏的疗效观察[J].临床心血管病杂志, 2014, 30(5):393-396.
[4] 宋明才, 雷汉东, 张稳柱, 等.急性心肌梗死并泵衰竭早期应用主动脉内球囊反搏对预防心源性休克的临床价值[J].实用医学杂志, 2011, 27(21):3886-3888.
[5] Yumun G, Aydin U, Ata Y, et al.Analysis of clinical outcomes of intra-aortic balloon pump during coronary artery bypass surgery[J].Cardiovasc J Afr, 2015, 26(3):130-133.
[6] Vales L, Kales L, Ephrem G, et al.Intra-aortic balloon pump use and outcomes with current therapies[J].J Invasive Cardiol, 2011, 23(3):116-119.
[7] 刘冬, 来永强, 章良, 等.主动脉内球囊反搏患者P-选择素与血小板减少症的相关性研究[J].心肺血管病杂志, 2013, 32(1):34-37.
[8] Valente S, Lazzeri C, Chiostri M, et al.Intra-aortic balloon pump in intensive cardiac care:a registry in Florence[J].Int J Cardiol, 2011, 146:238-239.
[9] Erdogan HB, Goksedef D, Erentug V, et al.In which patients should sheathless IABP be used? An analysis of vascular complications in 1211 cases[J].J Card Surg, 2006, 21(4):342-346.
[10] Cooper HA, Thompson E, Panza JA.The role of heparin anticoagulation during intra-aortic balloon counterpulsation in the coronary care unit[J].Acute Card Care, 2008, 10(4):214-220.
[11] 任海波, 李颖, 危宇, 等.主动脉内球囊反搏在冠状动脉旁路移植术后应用时机研究[J].中国胸心血管外科临床杂志, 2015, 22(7):653-656.
[12] Christenson JT, Sierra J, Romand JA, et al.Long intraaortic balloon treatment time leads to more vascular complications[J].Asian Cardiovasc Thorac Ann, 2007, 15(5):408-412.
[13] 边宁, 张涛, 张爱东, 等.IABP置入下行急诊PCI术患者使用磺达肝癸钠的有效性与安全性研究[J].临床心血管病杂志, 2014, 30(5):380-383.
[14] Allen SJ.Gastrointestinal complications and cardiac surgery[J].J Extra Corpor Technol, 2014, 46(2):142-149.
-
计量
- 文章访问数: 439
- PDF下载数: 110
- 施引文献: 0
下载: