Moriyama Y, Iguro Y, Shimokawa S, Saigenji H, Toyohira H, Taira A
Second Department of Surgery, Kagoshima University, School of Medicine, Japan.
Angiology. 1996 Jun;47(6):595-9. doi: 10.1177/000331979604700608.
The authors report a successful application of hypothermia, along with intra-aortic balloon pump (IABP) support, to postcardiotomy ventricular failure. Surface-cooling hypothermia was applied in 8 patients after open heart surgery. The original cardiac procedure consisted of 3 aortocoronary bypass graftings (ACBGs), 2 aortic valve replacements (AVRs), 1 repair for left ventricular (LV) rupture after mitral valve replacement (MVR), 1 MVR + ACBG, and 1 MVR + AVR + tricuspid valve annuloplasty (TAP). Their ages ranged from fifty-two to sixty-eight years with a mean of sixty-one years. Hemodynamic criteria for induction of hypothermia included cardiac index (CI) less than 2.0 L/min/m2 with left atrial pressure greater than 18 mmHg despite the use of IABP and maximum pharmacologic support. Blood temperature was maintained at around 33 degrees C. By six hours after induction of hypothermia the tissue oxygen consumption decreased significantly with no hemodynamic deterioration as compared with that before cooling. The duration of hypothermia ranged from thirty-six to one hundred fifty-nine hours with a mean of seventy-eight hours. All 8 patients finally discontinued IABP support with a mean driving time of one hundred thirty-two hours. Five of them were ultimately discharged from the hospital and returned to their previous life-style. The authors believe that, from the perspective of monetary and personal resources, the use of hypothermia with IABP support could be a therapeutic option for patients with postcardiotomy ventricular failure.
作者报告了低温疗法联合主动脉内球囊反搏（IABP）支持在心脏术后心室衰竭中的成功应用。8例心脏直视手术后患者采用体表降温的低温疗法。最初的心脏手术包括3例主动脉冠状动脉搭桥术（ACBG）、2例主动脉瓣置换术（AVR）、1例二尖瓣置换术（MVR）后左心室（LV）破裂修补术、1例MVR + ACBG以及1例MVR + AVR + 三尖瓣环成形术（TAP）。他们的年龄在52岁至68岁之间，平均年龄为61岁。诱导低温的血流动力学标准包括尽管使用了IABP和最大药物支持，但心脏指数（CI）仍小于2.0 L/min/m²且左心房压力大于18 mmHg。体温维持在33℃左右。与降温前相比，诱导低温6小时后组织氧耗量显著下降，且血流动力学无恶化。低温持续时间为36至159小时，平均为78小时。所有8例患者最终均停止了IABP支持，平均使用时间为132小时。其中5例最终出院并恢复了之前的生活方式。作者认为，从金钱和个人资源的角度来看，低温疗法联合IABP支持对于心脏术后心室衰竭患者可能是一种治疗选择。
