CAJ | 학술논문

目的回顾性总结危重冠心病围术期应用主动脉内球囊反博(1ABP)的经验,分析IABP置入的时机与临床治疗结果的关系,为提高IABP在危重冠心病患者的临床应用疗效提供依据.方法 1999年7月-2009年7月行冠状动脉搭桥术385例,其中21例病人围术期应用IABP辅助.将21例分为预防性主动置入组(主动组)8例和紧急被动置入组(被动组)13例.观察两组病人IABP使用的临床效果,包括围术期死亡率、IABP置入相关的严重并发症、平均辅助时间、血压改善情况、呼吸机辅助时间、ICU治疗时间等临床指标.结果本组IABP应用占同期冠心病外科手术病人的5.5%.21例病人中,存活15例,死亡6例,总有效率71%,主动组术后死亡率明显低于被动组(P＜0.01).两组的血压上升幅度、呼吸机辅助时间和ICU治疗时间差异有显著性(P＜0.05),但两组的术后并发症发生率、IABP辅助时间差异无显著性(P＞0.05).结论对于术前评估为危重冠心病患者,术前预防性主动置入IABP能明显改善心功能,降低术后死亡率,缩短呼吸机辅助时间和ICU治疗时间,充分发挥IABP临床疗效.
목적 회고성총결위중관심병위술기응용주동맥내구낭반박(1ABP)적경험,분석IABP치입적시궤여림상치료결과적관계,위제고IABP재위중관심병환자적림상응용료효제공의거.방법 1999년7월-2009년7월행관상동맥탑교술385례,기중21례병인위술기응용IABP보조.장21례분위예방성주동치입조(주동조)8례화긴급피동치입조(피동조)13례.관찰량조병인IABP사용적림상효과,포괄위술기사망솔、IABP치입상관적엄중병발증、평균보조시간、혈압개선정황、호흡궤보조시간、ICU치료시간등림상지표.결과 본조IABP응용점동기관심병외과수술병인적5.5%.21례병인중,존활15례,사망6례,총유효솔71%,주동조술후사망솔명현저우피동조(P＜0.01).량조적혈압상승폭도、호흡궤보조시간화ICU치료시간차이유현저성(P＜0.05),단량조적술후병발증발생솔、IABP보조시간차이무현저성(P＞0.05).결론 대우술전평고위위중관심병환자,술전예방성주동치입IABP능명현개선심공능,강저술후사망솔,축단호흡궤보조시간화ICU치료시간,충분발휘IABP림상료효.
Objective To review the perioperative application of intra-aortic balloon pump (IABP) in high-risk coronary artery bypass grafting (CABG), and to analyze the relation between inserting time and clinical outcomes.Methods From July 1999 to July 2009, 385 patients underwent CABG and 21 of them were supported with IABP in our hospital. 21 were divided into two groups : group A (8 cases) supported preoperatively, and group B (13 cases) supported urgently. Postoperative mortality, severe IABP-related complications, supporting time, improvement of blood pressure, ventilation time, and length of ICU stay were compared. Results Of the patients undergoing CABG, IABP was 5.5%. 15 of all the patients survived. The rate of efficacy was 71%. Mortality was lower in group A than in group B (12.5%±2.1% vs. 38.5%±4.3%,P<0.01). There were significant differences between the two groups in improvement of blood pressure (35.4 ± 4.6 in group A vs. 18.2 ± 3.0 in group B, P<O.O1), ventilation time (38.3 ± 4.9 vs. 89.6 ± 6.8, P<O.001), and length of ICU stay (89.3 ± 6.2 vs. 122.7 ± 9.1, P<0.01). Conclusions Preoperative use of IABP in high-risk patients undergoing CABG can significantly decrease the postoperative mortality, ventilation time, and length of ICU stay.