摘要
目的探讨左心辅助（left ventricular assist device，LVAD）、体外膜式氧合（extracorporeal membrane oxvgenation ECMO）、主动脉内气囊反搏（intra-aortic balloon pump，IABP）等循环辅助装置应用过程中的相关并发症，为临床工作提供借鉴。方法回顾2005年1月至2007年2月北京安贞医院心脏外科监护病房（ICU）收治的8306例心脏手术术后患者的临床资料，其中246例患者因急性心肺功能衰竭进行机械循环辅助，女性63例，男性183例，年龄（56．7±14．2）岁。LVAD辅助3例，均为左心房-升主动脉转流；ECMO辅助48例，2例为股静脉-股静脉转流，5例为股静脉-升主动脉转流，41例为股静脉-股动脉转流；IABP辅助195例，均经股动脉穿刺法置入（Seldinger法）。对三种机械循环方式辅助期间相关并发症进行比较分析。结果全组死亡78例，死亡率为31．7％；71例患者治疗过程中发生各种并发症，发生率为28．9％；主要相关并发症为感染27例、肾功能衰竭需要透析27例、出血24例、溶血6例、外周血管损伤15例、脑并发症6例，血浆渗漏及氧合器氧合能力下降中途更换7例。结论减少并发症的发生对提高机械循环辅助患者抢救成功率至关重要。
Objetctive To summarize the associated complications with circulatory support device, and provide reference for clinical practice. Method A total of 8306 consecutive patients who underwent open heart surgery, in Department of Post-operation Intensive Care Unit of the Cardiac Surgery, Anzhen Hospital, Capital Medical University, was retrospectively studied from January 2005 to February 2007. And the clinical data of 246 patients including 63 female and 183 male patients with mean age 56.7 ± 14.2 years supported with various circulatory support devices for perioperative cardiorespiratory function failure in ICU were analyzed. Left ventricular assist device （LVAD） was used in 3 patients by the cannulation of the left atrium and ascending aorta. The extracorporeal membrane oxygenation（ECMO） was established in 48 patients for postoperative cardiorespiratory function failure. The venoarterial hypass was established by cannulation of the right atrium in 41 patients and femoral artery and of venovenous in 2 patients, and of the right atrium and ascending aorta in 5 cases. Intra-aortie balloon pumping（ I- ABP）was performed via the femoral artery either percutaneously by the Seldinger technique in 195 patients. The cardiac operations included coronary artery bypass grafting （ n = 170）, coronary artery bypass grafting with remoldingof left ventricle （ n = 22）, coronary artery bypass grafting with valvular operation （ n = 10）, valvular operation （ n = 27）, heart transplantation （ n = 8）, correction of congenital heart defects （ n = 6）, aortic operations （ n = 2）. The duration of circulatory support ranged from 4 to 451 hours. Correlative complications of 3 kinds of circulatory support device were compared and repair of ventricular septal perforation in the wake of acute myocardial infarction （n = 1）. Results Seventy-eight （31.7%） patients died. Seventy-one（28.9%） patients developed various complications including infection （ n = 27）, renal failure required renal replacement therapy （ n = 27）, re-exploration for bleeding （ n = 24）, haemolysis （ n = 6）, limb ischemia （ n = 15）, neurological complications （ n = 6）, oxygenator failure （ n = 7） Conclusions The improvement of management to reduce complications may result in improved outcomes of patients supported with circulatory support devices.
出处
《中华急诊医学杂志》
CAS
CSCD
2008年第8期867-869,共3页
Chinese Journal of Emergency Medicine
关键词
左心室辅助
体外膜式氧合
主动脉内气囊反搏
并发症
Left ventricular assist device
Extracorporeal membrane oxygenation
Intra-aortic balloon pump
Complication
