单中心心脏手术中主动脉内球囊反搏的围手术期应用经验。

Single-centre experience with perioperative use of intraaortic balloon pump in cardiac surgery.

机构信息

Atatürk Training and Research Hospital, Cardiovascular Surgery Department, Ankara, Turkey.

出版信息

Heart Lung Circ. 2014 May;23(5):475-81. doi: 10.1016/j.hlc.2013.11.005. Epub 2013 Nov 26.

DOI:10.1016/j.hlc.2013.11.005

PMID:24345379

Abstract

BACKGROUND

Intraaortic balloon pump (IABP) is frequently used in cardiac surgery in order to prevent or treat low cardiac output syndrome. Although being widely used and forming the first line therapy in these haemodynamically unstable patients despite maximal medication, optimal timing for IABP insertion is still discussed. This retrospective study evaluates hospital outcomes of patients receiving IABP at preoperative, intraoperative and postoperative periods during cardiac surgery.

MATERIALS AND METHODS

Between 2006 and 2012, 2196 patients underwent open cardiac surgery in our centre. IABP was used in 121 (5.4%) patients. Nine patients had preoperative IABP insertion, 76 patients (62.8%) had intraoperative insertion to ease weaning from cardiopulmonary bypass, and 36 patients (29.8%) had postoperative insertion in the intensive care unit mainly due to refractory haemodynamic instability. Hospital outcomes of these 121 patients were analysed retrospectively.

RESULTS

The majority of the patients were male (men 89, 73.6% and women 32, 26.4%; mean age was 65.9±11.5 years). Among the cohort 87 (71.9%) underwent isolated coronary artery bypass surgery (CABG) and the rest (34 patients, 28.1%) were operated for valve disease with/without CABG or for CABG with carotid endarterectomy, left ventricular aneurysm repair, post myocardial infarction ventricular septal defect or pathologies involving ascending aorta. The overall hospital mortality of the whole cohort was 27.3%. Mortality rates according to IABP timing were 33.3%, 19.7% and 41.7% for pre, intra and postoperative insertion, respectively. Logistic regression analysis identified female gender, low ejection fraction (<30%), complex surgery and postoperative insertion as risk factors for mortality.

CONCLUSION

IABP insertion timing in cardiac surgery is crucial and many reports advocate early insertion since patient outcomes are poor for late insertions. This single centre study also confirms that the least favourable results are among patients with postoperative IABP insertion.

摘要

背景

主动脉内球囊反搏（IABP）常用于心脏手术，以预防或治疗低心输出综合征。尽管在这些血流动力学不稳定的患者中广泛应用，并在最大程度的药物治疗下作为一线治疗，但 IABP 的最佳插入时机仍存在争议。本回顾性研究评估了在心脏手术期间接受 IABP 术前、术中及术后的患者的医院结局。

材料与方法

2006 年至 2012 年间，我们中心有 2196 例患者接受了心脏直视手术。121 例（5.4%）患者使用了 IABP。9 例患者术前植入 IABP，76 例（62.8%）患者术中植入以方便从心肺旁路机脱机，36 例（29.8%）患者术后在重症监护病房植入，主要是由于难治性血流动力学不稳定。回顾性分析这 121 例患者的医院结局。

结果

大多数患者为男性（男性 89 例，占 73.6%；女性 32 例，占 26.4%；平均年龄为 65.9±11.5 岁）。该队列中 87 例（71.9%）患者接受了单纯冠状动脉旁路移植术（CABG），其余 34 例（28.1%）患者因瓣膜疾病、CABG 或 CABG 合并颈动脉内膜切除术、左心室室壁瘤修复、心肌梗死后室间隔缺损或升主动脉病变而接受手术。全组患者的院内死亡率为 27.3%。根据 IABP 时机，术前、术中及术后插入的死亡率分别为 33.3%、19.7%和 41.7%。Logistic 回归分析发现，女性、射血分数低（<30%）、复杂手术和术后插入是死亡的危险因素。