Litton E, Delaney A
Department of Intensive Care Medicine, Royal Perth Hospital, WA, Australia ; School of Medicine and Pharmacology, University of Western Australia, WA, Australia.
HSR Proc Intensive Care Cardiovasc Anesth. 2013;5(1):33-9.
Patients undergoing cardiac surgery increasingly have greater comorbidities and subsequently are at higher risk of adverse postoperative outcomes. Despite some evidence suggests that prophylactic intraaortic balloon counterpulsation reduces mortality in selected high-risk patients, its use remains low. The aim of this study was to investigate reported management strategies of high-risk patients and attitudes towards further research in this area.
A 22-question survey was developed and distributed electronically to all practicing cardiothoracic fellows through the email list of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons.
The response rate was 28% (n=31). Reported use of prophylactic intraaortic balloon counterpulsation varied depending on the specified preoperative indication. Prophylactic intraaortic balloon counterpulsation was used occasionally or never by the majority of respondents for their patients with characteristics similar to those of previous trials. The most frequent reason given for not using prophylactic intraaortic balloon counterpulsation was lack of data (42.9%), with a willingness to consider participation in an randomised controlled trial of prophylactic intraaortic balloon counterpulsation by a large majority of respondents (79.3%).
The majority of surgeons who responded to this survey do not routinely use prophylactic intraaortic balloon counterpulsation for high-risk patients. Further prospective data is warranted to ascertain whether potential barriers to a randomised control trial of prophylactic intraaortic balloon counterpulsation, such as adequate patient numbers and clear selection criteria, can be overcome.
接受心脏手术的患者合并症越来越多，术后不良结局的风险也相应更高。尽管有证据表明预防性主动脉内球囊反搏可降低特定高危患者的死亡率，但其使用率仍然较低。本研究的目的是调查高危患者报告的管理策略以及对该领域进一步研究的态度。
设计了一份包含22个问题的调查问卷，并通过澳大利亚和新西兰心胸外科医师协会的电子邮件列表以电子方式分发给所有在职心胸外科住院医师。
回复率为28%（n = 31）。报告的预防性主动脉内球囊反搏的使用情况因术前特定指征而异。大多数受访者对具有与先前试验相似特征的患者偶尔使用或从不使用预防性主动脉内球囊反搏。不使用预防性主动脉内球囊反搏最常见的原因是缺乏数据（42.9%），绝大多数受访者（79.3%）愿意考虑参与预防性主动脉内球囊反搏的随机对照试验。
参与本次调查的大多数外科医生对高危患者不常规使用预防性主动脉内球囊反搏。需要进一步的前瞻性数据来确定预防性主动脉内球囊反搏随机对照试验的潜在障碍，如足够的患者数量和明确的选择标准，是否能够克服。
