Kazui T, Komatsu S
Rinsho Kyobu Geka. 1989 Jun;9(3):252-7.
Between April, 1984 and December, 1988, 450 adult patients underwent open heart surgery for the valvular heart disease (VHD) and ischemic heart disease (IHD) in our institution. As the postoperative complication, LOS was observed in 33 patients with VHD (14.2%), and in 27 patients with IHD (12.4%) with no significant difference between the two groups. Treatment for LOS employed in this series consisted of pharmacological therapy in 11 patients, IABP in 42, IABP+veno-arterial bypass (VAB) in 5, right heart bypass (RHB)+IABP in 1 and left ventricular assist device (LVAD)+IABP in 1. All patients who were treated by the pharmacological therapy were alive and were discharged. Eighty-one % of the patients who were assisted with IABP were able to weaned off IABP, and 57% of the patients were alive and were discharged. All patients who were assisted with IABP+VAB died of LOS within 3 days after the operation. One patients who was assisted with RHB+IABP for pulmonary hypertension after emergency re-MVR and the other patient with LVAD+IABP for LOS after emergency CABG were able to be weaned off the assisted circulation and were discharged from the hospital. The salvage rate of patients with IHD by mechanical assisted circulation was generally higher than that of patients with VHD. Because of the limitation of IABP or VAB effect on the hemodynamic, LVAD directly assisted cardiac function would be indicated for severe LOS following open heart surgery without delay.
1984年4月至1988年12月期间，我院450例成年患者因瓣膜性心脏病（VHD）和缺血性心脏病（IHD）接受了心脏直视手术。作为术后并发症，33例VHD患者（14.2%）和27例IHD患者（12.4%）出现了低心排血量综合征（LOS），两组之间无显著差异。本系列中LOS的治疗方法包括11例患者采用药物治疗，42例采用主动脉内球囊反搏（IABP），5例采用IABP+静脉-动脉旁路（VAB），1例采用右心旁路（RHB）+IABP，1例采用左心室辅助装置（LVAD）+IABP。所有接受药物治疗的患者均存活并出院。接受IABP辅助的患者中，81%能够撤离IABP，57%的患者存活并出院。所有接受IABP+VAB辅助的患者均在术后3天内因LOS死亡。1例在急诊再次二尖瓣置换术后因肺动脉高压接受RHB+IABP辅助的患者，以及另1例在急诊冠状动脉旁路移植术后因LOS接受LVAD+IABP辅助的患者，均能够撤离辅助循环并出院。机械辅助循环对IHD患者的挽救率总体高于VHD患者。由于IABP或VAB对血流动力学的影响有限，对于心脏直视手术后严重的LOS，应立即使用LVAD直接辅助心脏功能。
