摘要
目的:总结主动脉内球囊反搏(IABP)联合体外膜肺氧合(ECMO)在左心功能严重受损患者中的治疗经验。方法:回顾性分析我院12例心脏术后严重心源性休克需同期采用IABP和ECMO辅助患者的临床资料,调查患者术前基本情况、临床诊断、辅助原因、机械辅助时间、并发症及预后。以患者院内死亡或生存结果,将患者分为2组。选取6个时间点,分别是机械循环辅助前、使用一种机械辅助后、使用第2种机械辅助前、IABP联合ECMO使用后、撤除ECMO后及撤除IABP后;整理分析患者血流动力学参数、血气指标、血管活性药物使用剂量及肝肾功能指标等情况。结果:6例存活出院,其中1例肾衰竭行血滤4d后恢复,后因插管侧动脉栓塞截肢。6例死亡患者全部发生肾衰竭,其中3例行血滤;3例发生下肢缺血坏死。患者的血流动力学指标、血管活性药物剂量、血气血乳酸值在联合使用IABP和ECMO后显著改善(P<0.05)。结论:IABP与ECMO联合应用为严重左心功能不全患者的救治提供了新的机遇。
Objective：To summarize the clinical experience of intra aortic balloon pumping（IABP） combined with extracorporeal membrane oxygenation（ECMO） for treatment profound postcardiotomy cardiogenic shock in adults.Methods：Reviewed the clinical protocols of 12 patients requiring contemporary venoarterial ECMO plus IABP for hemodynamic support in our heart center.We retrospectively summarized and analyzed the clinical data of these patients.Recorded demographics,diagnosis,mechanical circulatory assist duration,complications and in-hospital mortality.Hymodynamic parameters,blood gas,serum lactate,creatine,urea nitrogen were collected at the following intervals：before mechanical circulatory assist,after IABP or ECMO alone,before combined IABP and ECMO,after combined IABP and ECMO,after ECMO weaned off,after IABP weaned off.Results：6 patients were survival to hospital discharge.One of survivors presented renal failure and need for renal replacement therapy during ECMO,and then received amputation due to lower limb necrosis.Renal failure occurred in all of nonsurvivors,and 3 cases need renal replacement therapy.3 cases of nonsurvivors occurred severe lower limb ischemia.The parameters related to hymodynamic,blood gas and serum lactate were improved significantly after combined IABP and ECMO in all patients（P 0.05）.Conclusion：Adequate combined IABP with ECMO provide a reasonable way for treating profound postcardiotomy cardiogenic shock patients.
出处
《心肺血管病杂志》
CAS
2010年第6期480-485,共6页
Journal of Cardiovascular and Pulmonary Diseases
基金
教育部博士点基金(20060023045)
关键词
主动脉内球囊反搏
体外膜肺氧合
心源性休克
血液循环衰竭
Intra aortic balloon pumping
Extracorporeal membrane oxygenation
Cardiogenic shock
Circulation failure
