Cardiothoracic Intensive Care Unit and Greenlane Department of Anaesthesia, Auckland City Hospital, Park Road, Grafton, Auckland 1011, New Zealand.
Best Pract Res Clin Anaesthesiol. 2012 Jun;26(2):231-46. doi: 10.1016/j.bpa.2012.03.005.
In this article, the routine postoperative care and complications of patients with ventricular assist devices are reviewed. Routine postoperative care encompasses patients who have undergone emergency ventricular assist device (VAD) implantation for acute cardiogenic shock, as a bridge to decision making, and semi-elective patients who have undergone VAD implantation for end-stage heart failure, either as destination therapy or as a bridge to heart transplantation. Early postoperative management should focus on haemodynamic optimisation, including fluid and inotrope therapy, VAD settings and support of right ventricular function. Echocardiography is an essential tool in optimising haemodynamics and identifying complications. Early postoperative complications include bleeding, arrhythmias, right ventricular failure and infection. Late postoperative problems include bleeding, thrombosis and thrombo-embolism, device failure and psychological problems. In a small percentage of patients, weaning and explantation of the VAD are possible. For patients undergoing VAD implantation for destination therapy, end-of-life care planning should form part of the multidisciplinary care of the patient.
本文回顾了心室辅助装置患者的常规术后护理和并发症。常规术后护理涵盖了因急性心源性休克而接受紧急心室辅助装置（VAD）植入作为决策桥梁的患者，以及因终末期心力衰竭而接受 VAD 植入的半择期患者，无论是作为终末期治疗还是作为心脏移植的桥梁。术后早期管理应侧重于血流动力学优化，包括液体和正性肌力药物治疗、VAD 设置和右心室功能支持。超声心动图是优化血液动力学和识别并发症的重要工具。术后早期并发症包括出血、心律失常、右心衰竭和感染。晚期术后问题包括出血、血栓形成和血栓栓塞、设备故障和心理问题。在一小部分患者中，VAD 可以脱机和移除。对于因终末期治疗而接受 VAD 植入的患者，临终关怀计划应作为患者多学科护理的一部分。
