张涛,刘晓君,臧晓青,王刚,纪德江

• 1:青岛阜外心血管病医院心脏中心

摘要(Abstract)：

目的探讨主动脉内球囊反搏(intra-aortic balloon pump,IABP)在冠状动脉旁路移植术(coronary artery bypass grafting,CABG)围术期患者中的应用价值。方法回顾性分析2010年10月至2015年2月青岛阜外心血管病医院63例CABG围术期应用IABP患者的临床资料及IABP置入的时机、适应证、IABP辅助前后血流动力学变化、预后等。结果 63例患者中,术前置入IABP者6例,术中36例,术后21例。IABP辅助时间16~196(85.5±33.8)h,均未出现IABP相关并发症。IABP置入后4 h,患者的桡动脉平均压[(62.7±10.1)mm Hg比(53.6±11.7)mm Hg]、尿量[(0.83±0.22)ml/(kg·h)比(0.28±0.13)ml/(kg·h)]较置入前显著上升(均P<0.05),心率[(96±16)次/min比(103±17)次/min]、中心静脉压[(10.2±2.1)mm Hg比(14.5±2.3)mm Hg]、多巴胺用量[(6.5±0.4)μg/(kg·min)比(7.6±0.6)μg/(kg·min)]、肾上腺素用量[(0.050±0.016)μg/(kg·min)比(0.074±0.010)μg/(kg·min)]较置入前显著下降(均P<0.05)。入住ICU时间4~30(13.2±3.8)d,58例康复出院,5例临床死亡,死亡率为7.9%。随访58例患者12个月,存活率为100%。结论在CABG围术期使用IABP辅助安全有效,能够快速纠正血流动力学紊乱。

关键词(KeyWords)： 冠状动脉旁路移植术;围术期;主动脉内球囊反搏

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张涛,刘晓君,臧晓青,王刚,纪德江

参考文献(References)：

• [1]De Silva K,Lumley M,Kailey B,et al.Coronary and microvascular physiology during intra-aortic balloon counterpulsation.JACC Cardiovasc Interv,2014,7(6):631-640.
• [2]Etienne PY,Papadatos S,Glineur D,et al.Reduced mortality in high-risk coronary patients operated off pump with preoperative intraaortic balloon counterpulsation.Ann Thorac Surg,2007,84(2):498-502.
• [3]Mannacio V,Tommaso LD,Amicis VD,et al.Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization.Ann Thorac Surg,2012,93(3):804-809.
• [4]Christen JT,Simonet F,Badel P,et al.Optimal timing of preoperative intra-aortic balloon pump support in high-risk coronary patients.Ann Thorac Surg,1999,68(3):934-939.
• [5]丁文军,魏强,孙勇新,等.主动脉内球囊反搏在高危患者非体外循环冠状动脉旁路移植术中的应用.中国胸心血管外科临床杂志,2013,20(1):10-14.
• [6]高志伟,黄英姿,赵红梅,等.主动脉内球囊反搏对接受不同血管重建急性心肌梗死患者预后影响的荟萃分析.中华心血管病杂志,2016,44(7):588-593.
• [7]Ihdayhid A,Chopra S,Rankin J.Intra-aortic balloon pump:indications,efficacy,guidelines and future directions.Curr Opin Cardiol,2014,29(4):285-292.
• [8]Windecker S,Kolh P,Alfonso F,et al.2014 ESC/EACTS Guidelines on myocardial revascularization:The Task Force on Myocardial Revascularization of the European Society of Cardiology(ESC)and the European Association for CardioThoracic Surgery(EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions(EAPCI).Euro Heart J,2014,35(37):2541-2619.
• [9]Theologou T,Bashir M,Rengarajan A,et al.Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting.Cochrane Database Syst Rev,2011,1:CD004472.
• [10]Kapelios C,Terrovitis J,Siskas P,et al.Counterpulsation:a concept with a remarkable past,an established present and a challenging future.Inter J Cardiology,2014,172(2):318-325.
• [11]张晗,来永强,李进华,等.主动脉内球囊反搏在高危冠状动脉旁路移植术的应用.中华胸心血管外科杂志,2012,28(1):24-27.
• [12]Kogan A,Preisman S,Sternik L,et al.Heparin-free management of intra-aortic balloon pump after cardiac surgery.J Cardiac Surgery,2012,27(4):434-437.
• [13]Ferguson JJ 3rd,Cohen M,Freedman RJ Jr,et al.The current practice of intra-aortic balloon counterpulsation:results from the Benchmark Registry.J Am Coll Cardiol,2001,38(5):1456-1462.
• [14]刘锋,万彩红,赵岩岩,等.主动脉内球囊反搏在非体外循环冠状动脉旁路移植术前的预防性应用.中国体外循环杂志,2013,11(3):154-157.