Han Xin, Yao Yun-Tai
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, 100037 Beijing, China.
Department of Anesthesiology, Lishui People's Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, 323000 Lishui, Zhejiang, China.
Rev Cardiovasc Med. 2022 Aug 24;23(9):291. doi: 10.31083/j.rcm2309291. eCollection 2022 Sep.
In view of the role of mechanical circulatory support in patients with severe cardiac insufficiency during perioperative period, we searched the relevant articles on mechanical circulatory support at Fuwai Hospital, and analyzed the indications and complications of different mechanical circulatory support methods.
Relevant studies were identified by computerized searches of PubMed, Ovid, Embase, Cochrane Library, Wanfang Data, VIP Data, Chinese BioMedical Literature & Retrieval System (SinoMed), and China National Knowledge Infrastructure (CNKI), using search words ("intra-aortic balloon counter pulsation" OR "IABP" OR "extracorporeal membrane oxygenation" OR "ECMO" OR "ventricular assist device" OR "VAD") AND ("Fuwai" OR "fuwai"). All studies concerning the application of IABP, ECMO, and VAD at Fuwai Hospital were included, exclusion criteria included: (1) studies published as review, case report or abstract; (2) animal or cell studies; (3) duplicate publications; (4) studies lacking information about outcomes of interest.
A total of 36 literatures were selected for analysis. The specific mechanical circulatory support methods of ECMO and VAD retrieved from the studies were VA-ECMO and LVAD. The number of cases using IABP, ECMO, LVAD was 1968, 972, 67; and the survival rate was 80.4%, 54.9%, 56.7%, respectively. The major complications of IABP, ECMO and LVAD were hemorrhage (1.2%, 35.9% and 14.5%), infection (3.7%, 12.7% and 9.7%), acute kidney injury (9.1%, 29.6% and 6.5%), the secondary complications were limb ischemia, neurological events, cardiovascular events and thrombosis.
The present study suggested that, IABP, ECMO and VAD, either alone or in combination, were effective and safe mechanical circulation support when managing cardiovascular surgical patients with severe hemodynamic instability at Fuwai Hospital.
鉴于机械循环支持在严重心功能不全患者围手术期的作用，我们检索了阜外医院有关机械循环支持的相关文章，并分析了不同机械循环支持方法的适应证和并发症。
通过计算机检索PubMed、Ovid、Embase、Cochrane图书馆、万方数据、维普数据、中国生物医学文献数据库（SinoMed）和中国知网（CNKI），使用检索词（“主动脉内球囊反搏”或“IABP”或“体外膜肺氧合”或“ECMO”或“心室辅助装置”或“VAD”）以及（“阜外”或“fuwai”）来识别相关研究。纳入所有关于阜外医院IABP、ECMO和VAD应用的研究，排除标准包括：（1）以综述、病例报告或摘要形式发表的研究；（2）动物或细胞研究；（3）重复发表的研究；（4）缺乏感兴趣结局信息的研究。
共筛选出36篇文献进行分析。从研究中检索到的ECMO和VAD的具体机械循环支持方法为VA-ECMO和LVAD。使用IABP、ECMO、LVAD的病例数分别为1968例、972例、67例；生存率分别为80.4%、54.9%、56.7%。IABP、ECMO和LVAD的主要并发症分别为出血（1.2%、35.9%和14.5%）、感染（3.7%、12.7%和9.7%）、急性肾损伤（9.1%、29.6%和6.5%），次要并发症为肢体缺血、神经事件、心血管事件和血栓形成。
本研究表明，在阜外医院治疗严重血流动力学不稳定的心血管外科患者时，IABP、ECMO和VAD单独或联合使用都是有效且安全的机械循环支持手段。
