[1]陈会娟,孟树萍,胡延磊,等.主动脉内球囊反搏联合体外膜肺氧合治疗心脏手术后难治性心源性休克疗效观察[J].新乡医学院学报,2021,38(11):1037-1042.[doi:10.7683/xxyxyxb.2021.11.007]
　CHEN Huijuan,MENG Shuping,HU Yanlei,et al.Effect of intra-aortic balloon pump combined with extracorporeal membrane oxygenation in the treatment of refractory cardiogenic shock after cardiac surgery[J].Journal of Xinxiang Medical University,2021,38(11):1037-1042.[doi:10.7683/xxyxyxb.2021.11.007]
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主动脉内球囊反搏联合体外膜肺氧合治疗心脏手术后难治性心源性休克疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年11
页码:
1037-1042
栏目:
临床研究
出版日期:
2021-11-05

文章信息/Info

Title:
Effect of intra-aortic balloon pump combined with extracorporeal membrane oxygenation in the treatment of refractory cardiogenic shock after cardiac surgery
作者:
陈会娟; 孟树萍; 胡延磊; 王书鹏; 刘　超; 丁付燕; 刘富荣; 程兆云
（阜外华中心血管病医院/河南省人民医院心脏中心，河南　郑州　450003）
Author(s):
CHEN Huijuan; MENG Shuping; HU Yanlei; WANG Shupeng; LIU Chao; DING Fuyan; LIU Furong; CHENG Zhaoyun
（Fuwai Central China Cardiovascular Hospital/Heart Center of Henan Provincial People′s Hospital,Zhengzhou 450003,Henan Province，China）
关键词:
主动脉内球囊反搏; 体外膜肺氧合; 心源性休克; 心脏手术
Keywords:
intra-aortic balloon pumpextracorporeal membrane oxygenationcardiogenic shockcardiac surgery
分类号:
R54
DOI:
10.7683/xxyxyxb.2021.11.007
文献标志码:
A
摘要:
目的　探讨主动脉内球囊反搏(IABP) 联合体外膜肺氧合(ECMO) 治疗心脏手术后难治性心源性休克（RCS）患者的临床效果。方法　选择2016年1月至2020年1月于阜外华中心血管病医院/河南省人民医院行心脏外科手术且术后并发RCS的36例患者为研究对象，根据治疗方法将患者分为对照组（n=14）和观察组（n=22）。对照组患者给予ECMO辅助治疗，观察组患者给予IABP联合ECMO治疗。分别于治疗4 h(T1)、治疗24 h（T2）及撤出ECMO前（T3）检测2组患者的动脉收缩压、舒张动脉压、中心静脉压（CVP)和左心室射血分数（LVEF）等血流动力学指标以及血乳酸和肌酐值等血液辅助检查指标；比较2组患者血管活性药物评分(VIS)、ECMO辅助时间、心功能未恢复患者占比、重症监护室（ICU）住院时间、顺利撤机率、存活出院率等临床治疗效果及ECMO辅助治疗期间并发症和出院6个月后随访结果。结果　2组患者T2、T3时动脉收缩压、动脉舒张压及LVEF高于T1时，CVP低于T1时（P＜0.05）；2组患者T3时动脉收缩压、动脉舒张压及LVEF高于T2时，CVP低于T2时（P＜0.05）。T1时，观察组与对照组患者动脉收缩压、动脉舒张压、CVP及LVEF比较差异无统计学意义（P>0.05）。T2时，观察组患者动脉收缩压高于对照组（P＜0.05），2组患者动脉舒张压、CVP及LVEF比较差异无统计学意义（P>0.05）；T3时，观察组患者动脉收缩压、动脉舒张压及LVEF均高于对照组（P＜0.05），2组患者CVP比较差异无统计学意义（P>0.05）。2组患者T2、T3时VIS值及血乳酸水平低于T1时，血肌酐水平高于T1时（P＜0.05）；2组患者T3时VIS值及血乳酸水平低于T2时，血肌酐水平高于T2时（P＜0.05）。T1时，观察组与对照组患者VIS值及血乳酸、肌酐水平比较差异无统计学意义（P>0.05）。T2时，观察组患者VIS值及血乳酸低于对照组（P＜0.05），血肌酐水平与对照组比较差异无统计学意义（P>0.05）；T3时，观察组患者VIS值及血乳酸水平显著低于对照组（P＜0.05），血肌酐水平与对照组比较差异无统计学意义（P>0.05）。2组患者ECMO辅助时间比较差异无统计学意义（P>0.05）；观察组心功能未恢复患者占比显著低于对照组，ICU住院时间显著长于对照组，顺利撤机率及存活出院率显著高于对照组（P＜0.05）。对照组患者中6例因肾功能不全需行CRRT，2例手术创面出血，1例感染，并发症发生率为64.29%（9/14）；观察组患者中9例因肾功能不全需行CRRT，2例手术创面出血和1例消化道出血，2例感染，1例脑卒中，2例下肢缺血，并发症发生率为77.27%（17/22）。观察组与对照组患者并发症发生率比较差异无统计学意义（χ2=1.382,P>0.05）。出院随访6个月后，对照组1例存活者心功能美国纽约心脏病学会（NYHA） Ⅱ级。观察组患者7例存活，心功能NYHA Ⅱ~Ⅲ级；2例患者死亡，1例因术后行华法林抗凝治疗死于大面积脑出血，1例死于心脏骤停。结论　IABP联合ECMO 可显著改善心脏术后并发RCS患者的循环状态及组织灌注，减少血管活性药物应用，提高患者顺利撤机率和存活出院率。
Abstract:
Objective　To investigate the clinical effect of intra-aortic balloon pump (IABP) combined with extracorporeal membrane oxygenation (ECMO) in the treatment of refractory cardiogenic shock (RCS) after cardiac surgery.Methods　A total of 36 patients with postoperative RCS who underwent cardiac surgery at Fuwaihua Central China Cardiovascular Hospital/Henan Provincial People′s Hospital from January 2016 to January 2020 were selected as the research subjects.According to the treatment method,they were divided into control group (n=14) and observation group (n=22).The patients in the control group were received ECMO adjuvant therapy,and the patients in the observation group were received IABP combined with ECMO therapy.At 4 h of treatment(T1),24 h of treatment (T2) and before ECMO withdrawal (T3),the hemodynamic indexes such as systolic blood pressure,diastolic blood pressure,central venous pressure (CVP) and left ventricular ejection fraction (LVEF),as well as blood lactic acid and creatinine values were respectively detected.The clinical treatment effects including vasoactive-inotropic score (VIS),ECMO-assisted duration,the propertion of unrecovered cardiac function patients,the time of hospitalizoation in intensive care uint(ICU),the rate of successful withdrawal,the rate of survival at discharge,as well as complications during ECMO-assisted treatment and follow-up results within 6 months after discharge were compared between the two groups.Results　The systolic blood pressure,diastolic blood pressure and LVEF of patients in the two groups at T2 and T3 were significantly higher than those at T1,CVP was significantly lower than that at T1 (P<0.05)the systolic blood pressure,diastolic blood pressure and LVEF at T3 in the two groups were significantly higher than those at T2,CVP was significantly lower than that at T2 (P<0.05).At T1,there was no significant difference in systolic blood pressure,diastolic blood pressure,CVP and LVEF of patients between the two groups (P>0.05).At T2,the arterial systolic blood pressure of patients in the observation group was significantly higher than that in the control group (P<0.05)，there was no significant difference in arterial diastolic blood pressure,CVP and LVEF of patients between the two groups (P>0.05).At T3,the systolic blood pressure,diastolic blood pressure and LVEF of patients in the observation group were significantly higher than those in the control group (P<0.05),there was no significant difference in CVP of patients between the two groups (P>0.05).The VIS value and blood lactate level of patients in the two groups at T2 and T3 were significantly lower than those at T1,the blood creatinine was significantly higher than that at T1 (P<0.05)the VIS value and blood lactate level of patients in the two groups at T3 were significantly lower than those at T2,the blood creatinine was significantly higher than that at T2 (P<0.05).At T1,there was no significant difference in VIS value,blood lactic acid and creatinine levels between the two groups (P>0.05).At T2,the VIS value and blood lactate level of patients in the observation group were significantly lower than those in the control group (P<0.05),there was no significant difference in blood creatinine between the two groups (P>0.05)at T3,the VIS value and blood lactate level of patients in the observation group were significantly lower than those in the control group (P<0.05),there was no significant difference in serum creatinine level between the two groups (P>0.05).There was no significant difference in ECMO auxiliary time between the two groups (P>0.05)the proportion of unrecovered cardiac function patients in the observation group was significantly lower than that in the control group,the time of ICU stay was significantly longer than that in the control group,the rate of successful evacuation and the rate of survival at discharge were significantly higher than those in the control group (P<0.05).In the control group,6 patients needed CRRT due to renal insufficiency,2 patients suffered from wound bleeding,1 patient was infectedthe incidence of complication was 64.29% (9/14).In the observation group,9 patients needed CRRT due to renal insufficiency,2 patients had wound bleeding,1 patient had digestive tract bleeding,2 patients had infection,1 patient had cerebral stroke,2 patients had lower limb ischemiathe incidence of complication was 77.27% (17/22).There was no significant difference in the incidence of complications between the two groups (χ2=1.382,P>0.05).After 6 months of follow-up,the cardiac function of 1 survivor in the control group was New York heart association（NYHA） grade Ⅱ.In the observation group,7 patients survived with NYHA grade Ⅱ-Ⅲ cardiac functiontwo patients died,one died from massive cerebral hemorrhage due to postoperative warfarin anticoagulant therapy,and the other died from cardiac arrest.Conclusion　IABP combined with ECMO can significantly improve the circulatory state and tissue perfusion of patients with RCS after cardiac surgery,reduce the application of vasoactive drugs,and increase the rate of successful withdrawal and rate of survival at discharge.

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更新日期/Last Update: 2021-11-05