CAJ | 학술논문

目的探讨心脏围手术期应用主动脉球囊反搏(IABP)疗效影响因素及对策.方法回顾性分析心脏围手术期42例应用IABP患者的临床资料,将其分为生存组(32例)和死亡组(10例),比较两组植入IABP时机、术前心功能、术中体外循环(CPB)及主动脉阻断时间、植入IABP前平均动脉压(MAP)及正性肌力药物评分(IS)、术后并发症.结果死亡组中术前植入IABP2例、术中植入1例、术后植入7例.死亡组术前NYHA心功能分级Ⅲ～Ⅳ级8例,术中CPB及主动脉阻断时间分别为(144.43±49.03)、(97.29±39.99) min,植入IABP前MAP (57.34±7.25) mm Hg(1 mm Hg =0.133 kPa),植入IABP前IS(28.22±17.72)分,IABP时间(86.00±52.31) min,与生存组[分别为(100.43±35.03) min、(60.45±20.55)min、(69.34 ±8.05) mm Hg、(10.82±15.75)分、(49.00±25.23)min]比较差异均有统计学意义(P＜0.05).死亡组术后并发瘟包括呼吸机依赖7例,急性肾衰竭6例,难治性代谢性酸中毒5例,恶性心律失常2例,急性心肌梗死1例,明显高于生存组的0、4、2、0、0例,差异有统计学意义(P＜0.05).结论 IABP应用指征和时机不当、术前心功能差、术中CPB及主动脉阻断时间长、植入IABP前MAP＜60mmHg及正性肌力药物用量大是影响因素,术后并发症是影响IABP疗效的主要因素.合理选择适应证、准确把握应用时机、及时有效防治并发症有望提高IABP的疗效.
목적 탐토심장위수술기응용주동맥구낭반박(IABP)료효영향인소급대책.방법 회고성분석심장위수술기42례응용IABP환자적림상자료,장기분위생존조(32례)화사망조(10례),비교량조식입IABP시궤、술전심공능、술중체외순배(CPB)급주동맥조단시간、식입IABP전평균동맥압(MAP)급정성기력약물평분(IS)、술후병발증.결과 사망조중술전식입IABP2례、술중식입1례、술후식입7례.사망조술전NYHA심공능분급Ⅲ～Ⅳ급8례,술중CPB급주동맥조단시간분별위(144.43±49.03)、(97.29±39.99) min,식입IABP전MAP (57.34±7.25) mm Hg(1 mm Hg =0.133 kPa),식입IABP전IS(28.22±17.72)분,IABP시간(86.00±52.31) min,여생존조[분별위(100.43±35.03) min、(60.45±20.55)min、(69.34 ±8.05) mm Hg、(10.82±15.75)분、(49.00±25.23)min]비교차이균유통계학의의(P＜0.05).사망조술후병발온포괄호흡궤의뢰7례,급성신쇠갈6례,난치성대사성산중독5례,악성심률실상2례,급성심기경사1례,명현고우생존조적0、4、2、0、0례,차이유통계학의의(P＜0.05).결론 IABP응용지정화시궤불당、술전심공능차、술중CPB급주동맥조단시간장、식입IABP전MAP＜60mmHg급정성기력약물용량대시영향인소,술후병발증시영향IABP료효적주요인소.합리선택괄응증、준학파악응용시궤、급시유효방치병발증유망제고IABP적료효.
Objective To explore the therapeutic effect influencing factors of intra-aortic balloon pump(IABP) support during cardiac surgery perioperative period and countermeasures.Methods Clinical data of 42 patients using IABP in the cardiac surgery was analyzed retrospectively.The patients were classified into 2 groups:living group (32 patients) and died group (10 patients).The time of IABP implantation,preoperative cardiac function,the duration of cardiopulmonary bypass(CPB) and aorta block,mean arterial pressure (MAP) and inotropic score (IS) before using IABP and postoperative complications were recorded and compared.Results In died group,2 patients were used IABP preoperatively,1 patient was used intraoperatively,7 patients were used postoperatively,8 patients were in NYHA cardiac function class Ⅲ or Ⅳ preoperative,the duration of CPB and aorta block were (144.43 ± 49.03),(97.29 ± 39.99)min respectively,MAP and IS before using IABP were (57.34 ±7.25) mm Hg (1 mm Hg =0.133 kPa) and (28.22 ±17.72) scores,IABP time was (86.00 ±52.31) min.Compared with living group,all above comparisons showed significant difference [(100.43 ± 35.03) min,(60.45 ± 20.55) min,(69.34 ± 8.05)mm Hg,(10.82 ± 15.75) scores,(49.00 ± 25.23) min] (P ＜ 0.05).Postoperative complications in died group included 7 patients of ventilator dependency,6 patients of acute renal failure,5 patients of refractory metabolic acidosis,2 patients of malignant arrhythmia,1 patient of acute myocardial infarction,significantly higher than those in living group (0,4,2,0,0) (P ＜ 0.05).Conclusions Erroneously choose the timing of using IABP,poor preoperative cardiac function,prolonging CPB and aorta block time,MAP less than 60 mm Hg and high dose positive inotropic agent before using IABP,and postoperative complications are main influencing factors for clinical outcomes of IABP in cardiac surgery.Reasonably choosing adaptive indication and timing of IABP,preventing and treating postoperative complications effectively can improve effects of IABP in cardiac surgery.