主动脉内球囊反搏联合离心泵左心辅助治疗严重低心排血量综合征

目的：总结主动脉内球囊反搏(IABP)联合离心泵左心辅助治疗严重低心排血量综合征(LCOS)的经验。方法：2000～2004年,于北京大学第一医院心脏外科行冠状动脉旁路移植(CABG)术后出现严重的LCOS5例,在大量应用血管活性药物治疗无效情况下,应用IABP联合离心泵行左心辅助。离心泵经右上肺静脉和升主动脉插管连接。结果：所有患者血流动力学明显改善,联合辅助4～7d后均顺利脱离离心泵。辅助期间5例均出现了不同程度的血液细胞破坏和急性肾功能不全,其中3例在离心泵撤除后肾功能逐渐恢复正常,痊愈出院;1例死于急性肾功能衰竭;1例死于多脏器功能衰竭。5例均需补充全血或浓缩红细胞,4例需补充血小板。结论：IABP联合离心泵进行左心辅助,能明显改善CABG术后大剂量血管活性药物无效的严重LCOS的血流动力学,副作用为血液细胞破坏和急性肾功能不全。

Clinical application of intro-aortic balloon pump and centrifugal pump in low cardiac output syndrome after coronary artery bypass grafting

OBJECTIVE: To explore the clinical application of Intra-aortic balloon pump (IABP) and centrifugal pump in low cardiac output syndrome (LCOS) after coronary artery bypass grafting (CABG). METHODS: From April 2000 to January 2004, 5 patients suffered serious LCOS after CABG in our department. Because maximum vasoactive agent had no significant effect, we supported these 5 patients with IABP and centrifugal pumps. The centrifugal pumps were connected with cannulas of right superior pulmonary vein and ascending aorta. The flow rate of the centrifugal pumps were increased to 3-4 L/min gradually. The dosage of vasoactive agent and flow rate of the centrifugal pumps were decreased gradually after hemodynamics stabilized. RESULTS: All 5 patients' hemodynamics were improved significantly after the left ventricular assist by IABP and centrifugal pumps. Five patients were weaned from the centrifugal pumps after 4 to 7 days successfully. But some degree damage to blood cells and renal function were detected. Renal function of 3 patients were recovered gradually after centrifugal pumps removed and discharged successfully, One patient died of acute renal failure, 1 patient died of multiple organ failure, 5 patients need transfusion of whole blood or concentrated erythrocytes and 4 patients need transfusion of platelets. CONCLUSIONS: There were significant improvements in hemodynamics after support with IABP and centrifugal pumps in the patients who suffered serious LCOS with less effect of maximum vasoactive agent after CABG. Some complications on blood cells and renal function should be paid more attention.