主动脉内球囊反搏在冠状动脉旁路移植术病人围术期应用的观察护理

目的:观察主动脉内球囊反搏(IABP)在冠状动脉粥样硬化性心脏病(冠心病)病人公路转运途中的应用,总结其在冠状动脉旁路移植术(CABG)围手术期应用的护理体会。方法:收集56例CABG病人围手术期应用IABP的临床资料,回顾性分析并总结携带IABP病人转运的护理要点。结果:平均IABP辅助时间(103.2±87.6)h。救护车市内公路及高速公路转运IABP病人20例,未发生断电及机械故障,IABP管道无打结、脱出,转运过程中无心脏事件发生。结论:IABP作为简单有效的循环辅助手段之一,能提高高危CABG病人围手术期安全性,周密细致的观察护理,对于提高病人公路转运安全性尤为重要。     

体外循环与辅助循环在心脏急症中的应用

目的：应用体外循环与辅助循环方法救治围术期心脏急症病人。方法：紧急应用体外循环支持5例，其中3例同时进行原发心脏疾病的手术治疗。主动脉内球囊反搏（IABP）4例，左心辅助循环1例。结果：治愈7例，死亡3例。结论：体外循环与辅助循环，对围术期心脏危重急症病人是一种非常有效的治疗辅助措施。     

主动脉内球囊反搏术在心脏外科围术期应用的时机探讨

目的：探讨主动脉内球囊反搏术（IABP）在心脏外科围术期的应用时机。方法：回顾性调查5例心脏手术围术期使用IABP的患者，分析其术前资料、IABP应用时机和术后恢复情况。结果：术前应用IABP的3例冠心痛患者术后恢复良好；术后发生低心排综合征的1例患者经使用IABP12h后血流动力学渐稳定；因术中心肌保护不当再使用IABP的1例患者，术后48h死亡。结论：重症冠心病患者术前预防性使用IABP可增加手术安全性，经食管超声心动图（TEE）有助于判断心脏围术期IABP应用时机。     

心脏瓣膜手术患者围术期应用主动脉内球囊反搏辅助循环的临床护理

本文总结了93例围术期应用主动脉内球囊反搏装置辅助循环的心脏瓣膜手术患者的护理及其要点,包括置管前的准备与护理以及IABP置入术后的护理.58例患者成功撤机,35例因低心排综合征、感染性休克或迟发性心包填塞死亡.认为围术期使用IABP辅助循环的心脏瓣膜手术患者病情危重,在护理工作中了解IABP的基本工作原理,并在此基础上对此类患者的护理要点加以落实有助于提高IABP的辅助效果.     

主动脉球囊反搏在冠脉搭桥术围术期的应用及护理

主动脉内球囊反搏（intra—aortic balloon pamping,IABP）可提供血流动力学的支持和（或）手术前后对心肌缺血的控制,是目前应用广泛而有效的机械性循环辅助装置,尤其是在改善高危病人的手术结果和存活率等方面的价值无法衡量。2005年3月-2009年3月我科行冠脉搭桥术的患者中有11例在围术期应用IABP辅助,现报告如下。     

冠状动脉搭桥患者围手术期主动脉内球囊反搏应用的护理体会

主动脉内球囊反搏术(IABP)是最普通、最广泛的辅助循环方法,临床应用IABP可以通过改善心肌缺血、减少心肌耗氧量,增加心排出量,对冠状动脉搭桥围手术期的危重患者起到辅助心脏的作用[1],现报道如下. 临床资料 1.一般资料.我科自2008年4月至2010年7月共25例冠状动脉搭桥围术期应用IABP患者,年龄41～81岁,平均年龄(67.5±11.1)岁,其中男21例,女4例.     

心脏外科手术围手术期心功能不全应用IABP的监护

随着心脏外科技术不断发展，越来越多的心脏病患者受益于体外循环心脏手术。以IABP为首的辅助循环技术的发展更是为心源性休克、心脏直视手术后不能脱离人工心肺机及术后发生低心排出量综合症的患者带来新的生机。心脏外科病人在围手术期的心功能不全有其特殊性，如何正确使用好IABP，帮助患者平稳度过围手术期，显得尤为重要。我科医务人员经长期摸索总结出一套规范的操作流程及监护经验，现介绍如下。     

非体外循环冠状动脉旁路移植术在严重左室功能低下病人中的应用

目的探索严重左室功能低下的冠心病病人进行的非体外循环冠状动脉旁路移植术(OPCAB)的经验。方法回顾性分析2000-02~2004-10进行的选择性OPCAB手术34例的临床资料、手术资料、手术结果,总结围手术期治疗体会。结果全部病例均完成OPCAB手术,34例OPCAB病人行旁路移植2~5支,平均3.4±0.7支,使用主动脉内球囊反搏18例,其中16例均在手术中安放,应用IABP后血流动力学指标明显改善。围手术期死亡1例,死亡率2.9%,于术后29 d死于多器官功能衰竭。有2例术后出现急性左心衰,安放主动脉内球囊反搏后保守治疗好转。结论严重左室功能低下病人实施OPCAB手术有良好的可行性和近期效果,积极的术前准备,IABP的应用,完全的再血管化及正确的手术方法和配合是确保手术疗效的关键,而长期结果仍有待进一步观察。     

主动脉内球囊反搏在体外循环心脏手术后重症患者中的应用

主动脉内囊反搏(intraaotic balloon counter pulsation,IABP)是治疗围术期心力衰竭的有效机械辅助方法之一。作者回顾性分析2002年6月至2005年5月45例使用IABP治疗的重症体外循环心脏手术患者,现报告如下。     

主动脉内球囊反搏在体外循环心脏手术后病人中的应用和护理

目的探讨主动脉内球囊反搏(IABP)在体外循环心脏手术病人并发严重低心排、顽固性严重心律失常时应用的意义,介绍主动脉内球囊反搏(IABP)应用期间的护理体会和经验.方法5例体外循环心脏手术病人,术后合并有严重低心排综合征4例,合并有顽固性严重心律失常、心室停搏1例,均通过股动脉穿刺插入IABP导管于降主动脉内,用Detascope system 98型反搏仪进行辅助循环,多采用心电触发,选择R波高尖,T波低平的导联.监测动脉压、心电图波形、中心静脉压、尿量、末梢循环变化和升压药使用量等.结果本组病人应用IABP后,血压、心率逐渐平稳,室性心律失常消失,多巴胺、肾上腺素等升压药逐渐减量,使用IABP18～72小时,2例病人术后因并发多器官功能袁竭死亡.结论IABP有增加冠脉血流量,改善心肌供血、供氧,减轻心脏前后负荷,增加心肌收缩力和心排量的作用,正确和及时应用IABP多能扶助心脏渡过低心排期,可改善病人预后.在应用IABP期间应严密监测生命体征及辅助循环的效果,保持导管通畅,应用肝素抗凝,定时观察插管肢体的温度、颜色和足背动脉搏动情况,严格遵守操作规程,注意防止感染、血栓、栓塞、出血、肾功能损坏等并发症发生,提高IABP的抢救效果.     

心脏术后心源性休克的IABP治疗

目的报告应用主动脉内球囊反搏(IABP)治疗术后危重心脏病患者的疗效。方法对12例心脏手术后并发心源性休克及低心排的患者应用IABP治疗。其中双瓣置换术3例,二尖瓣置换加冠状动脉搭桥术2例,主动脉瓣置换加冠状动脉搭桥术1例,单纯冠状动脉搭桥术6例。结果9例顺利脱离IABP,成功率为75%(9/12)。结论IABP是抢救危重心脏病患者的有效措施,对危重心脏病有适应证者应及早使用。     

Assessment of intra-aortic balloon counterpulsation in cardiogenic shock.

Intra-aortic balloon pumping (IABP) has been shown to reverse the cardiogenic shock syndrome, but the long-term results (16 to 53% survival) have, in general, been disappointing. The most productive areas for the use of IABP are in the treatment of acute myocardial ischemia where in one report of 16 patients treated with IABP and surgery 15 survived and 13 were angina free, and in the open heart surgical setting where survival ranges from 42 to 70%. The implications of these treatment modalities are discussed.     

主动脉内球囊反搏在危重症心脏病中的应用及延长应用的安全性分析

目的 观察主动脉内球囊反搏(IABP)应用的疗效及延长应用的安全性.方法 回顾性分析2008年1月1日至2011年6月30日我院冠心病监护病房(CCU)应用IABP辅助治疗的患者30例,观察治疗前及治疗后24小时患者的各项血流动力学指标、尿量、血氧饱和度等变化.将IABP应用时间≥10天定义为延长应用,按是否延长应用分为长期治疗组和短期治疗组,观察两组并发症的发生率、病死率及生存时间.分析延长应用IABP的安全性.结果 ①所有患者在应用IABP治疗24小时后,临床症状均有明显改善,血流动力学指标、尿量、血氧饱和度等在治疗前、治疗后24小时的差异有统计学意义(P＜0.01).②长期治疗组与短期治疗组在并发症及病死率差异无统计学意义.两组生存时间差异无统计学意义.结论 应用IABP辅助治疗,不但可以有效改善患者心功能,对于肾功能及末梢循环同样有益.对于危重症心脏病患者,适当延长IABP应用时间在临床是可行的.     

Interêt du ballon de contre-pulsion intra-aortique dans le choc cardiogénique

Intra-aortic ballon pump (IABP) was developed during the 1960’s, with the idea to increase cardiac output and coronary perfusion in cardiogenic shock patients. These effects were confirmed by physiological studies, although of smaller magnitude than expected. Considered initially as a salvage therapy, IABP was largely used and strongly recommended until recently in the setting of cardiogenic shock following myocardial infarction. However, these recommendations were mainly based on studies with heterogeneous results and low methodology level (cohort studies or small randomized trials). The large multicenter randomized IABP SHOCK II trial failed to demonstrate any advantage of the IABP during acute myocardial infarction complicated with cardiogenic shock. Following the publication of that trial, IABP is not recommended anymore routinely in this pathology. Similarly, although preliminary studies suggested better outcomes with peri-operative IABP in coronary artery bypass surgery, more recent randomized trials failed to confirm any effect in this setting. Lastly, one of the remaining indication for the IABP is its potential use in patients supported by peripheral veno-arterial ECMO, to partially unload the left ventricle and therefore reduce the risk of pulmonary oedema related to the increased in left ventricular afterload induced by VA-ECMO.     

主动脉内球囊反搏在不停跳搭桥术中室颤后的应用

目的回顾性研究不停跳搭桥术中室颤后主动脉内球囊反搏的应用。方法本组患者是1998年1月至2005年12月本科收治的不停跳搭桥术中室颤后应用IABP者,共31例。结果31例患者死亡5例,占16．13%。死亡原因为：低心输出量综合征4例,其中合并肾功能衰竭3例,合并顽固性室性心律失常2例;无法脱离体外循环1例。结论IABP是一种安全的、行之有效的循环辅助方式,积极应用于高危冠心病患者,特别是在不停跳搭桥术中出现室颤后,可以明显提高治疗效果。     

Preoperative insertion of an intra-aortic balloon pump improved the prognosis of high-risk patients undergoing off-pump coronary artery bypass grafting

This study investigated the efficacy and safety of preoperative insertion of an intra-aortic balloon pump (IABP) in high-risk coronary atherosclerotic disease patients undergoing off-pump coronary artery bypass grafting (OPCAB). A total of 232 patients were recruited to the study, of whom 107 underwent percutaneous insertion of an IABP prior to OPCAB. The remaining 125 patients underwent OPCAB alone. Pre-, peri- and postoperative parameters were compared between the two groups. Preoperative insertion of an IABP was associated with a shorter stay in intensive care, decreased incidence of postoperative dialysis and acute heart failure, and a reduction in postoperative mortality compared with OPCAB alone. There were no between-group differences in terms of haematocrit level, number of distal anastomoses, volume of postoperative drainage or incidence of reoperation for bleeding and postoperative stroke/cerebrovascular accident. In conclusion, preoperative insertion of an IABP improved the prognosis of high-risk CAD patients undergoing OPCAB.     

心脏直视术后应用主动脉内球囊反搏患者的监护

通过对9例心脏直视术后应用主动脉内球囊反搏术（IABP)患者的监测和护理，总结了IABP围术期的监护要点。认为术前应对护理人员进行严格的培训，并做好充分的物品准备；术中掌握反搏仪常用的参数调节．正确识别反搏波并通过床旁血液动力学监测判断反搏效果；同时应密切观察肢体供血状况．保持良好体位并进行适当功能锻炼，预防肢体缺血或栓塞及皮肤溃疡的发生。     

急性心肌梗死泵衰竭患者急诊IABP的循环支持治疗

目的评价急性心肌梗死泵衰竭患者经急诊主动脉内气囊反搏术(intra-aortic balloon pump，IABP)循环支持治疗的可行性及其疗效。方法急性心肌梗死并发泵衰竭的患者一经确诊即予急诊IABP循环支持治疗，以同时期同一疾病未经IABP治疗的患者作为对照组进行比较，观察其循环复苏前后的血压、心率、心功能、脏器功能不全的发生数、30天病死率等变化。结果两组间年龄、性别、院前时间、冠状动脉病变支数、再发心梗次数及IABP治疗前心功能分级(Killip’s分级)、收缩压、舒张压差异无显著性；IABP循环支持治疗后较治疗前患者收缩压、舒张压、心功能分级明显提高，心率明显下降；治疗组较对照组器官功能不全发生数和30天病死率减低有非常显著意义。结论对急性心肌梗死并发症泵衰竭患者在急诊尽早进行IABP治疗具有明显的循环支持治疗效果，以便为进一步的治疗争取时间并能明显减少并发症、降低病死率。     

Effectiveness of ventilation-compression ratios 1:5 and 2:15 in simulated single rescuer paediatric resuscitation

BACKGROUND: Intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS) is suggested as bridging therapy to definite emergency revascularization, heart transplantation and acute valvular repair. Data concerning the use of IABP counterpulsation in an emergency department (ED) are rare. PATIENTS AND METHODS: We reviewed retrospectively the charts of patients who had been treated by IABP counterpulsation in the ED of a tertiary care university hospital during a 7-year period. We analyzed indications for IABP treatment, complications of IABP use and studied various predictors for 30-day survival. RESULTS: Overall 88 (68 male) patients, median age 60 years (IQR 53-69 years) were treated with IABP counterpulsation. CS was caused by acute coronary syndrome (ACS), acute cardiomyopathy decompensation of (CMP) and aortic stenosis (AS) in 77 (87%), ten (12%) and one (1%) patients, respectively. Complications attributed to the insertion or maintenance of IABP were observed in nine (10%) patients. Thirty four patients (38%; 24 male) survived. Compared to non-survivors, these patients were younger (56 vs. 63 years; P<0.023) and had significant lower serum lactate levels before IABP insertion (3 vs. 5.5 mmol/l; P<0.002). Logistic regression analysis identified age (P<0.04) and serum lactate serum level before IABP (P<0.01) as independent predictors for survival. In the 77 patients with ACS PTCA tended to be associated with a higher rate of survival (P<0.09). CONCLUSION: Initiation of IABP counterpulsation in patients with CS in an ED appears safe. Low levels of serum lactate and younger age were independent predictors of survival. In patients with ACS PTCA may contribute to improved outcome.     

Mechanical circulatory assistance by intra-aortic balloon pumping for the treatment of cardiogenic shock

Although the shock state due to acute myocardial infarction may be reversed by IABP in 80 per cent of patients, 55 to 65 per cent remain balloon-dependent. Therefore some attempt to correct the underlyng anatomic abnormalities (reversible ischaemic areas and/or mechanical defects) appears necessary if these patients are to sruvive. With IABP catheterization studies performed in these critically-ill patients are well tolerated. Moycardial depression after cardiopulmonary by-pass is often related to subendocardial ischaemia. The combination of IABP and surgery has resulted in survival of approximately 50 per cent of patients in cardiogenic shock secondary either to a mechanical defect complicating myocardial infarction or to open-heart surgery.