主动脉内球囊反搏术在不同心脏病术后应用效果的比较

目的：通过比较分析３种心脏病术后应用主动脉内球囊反搏术（ＩＡＢＰ）的效果，对于提高抢救成功率有所裨益。方法：１９８２年至１９９４年末，冠心病、风湿性心脏病、先天性心脏病和其他疾病分别有７５、３６、１２和４例因心脏术后严重低心输出量综合征应用ＩＡＢＰ。结果：冠心病、风湿性心脏病和先天性心脏病分别有６１（８１％）、１８（５０％）和２（１６％）例有效并撤除Ｉ－ＡＢＰ，其中５４（７２％）、１２（３３％）和２（１６％）例恢复出院，３种心脏病术后应用ＩＡＢＰ的效果差别非常显著（Ｐ＜０．００５）。冠心病４例桥阻塞，１例再次手术治愈，３例未再手术死亡，先天性心脏病１例左心室发育小，ＩＡＢＰ无效死亡。结论：冠心病效果最佳，风湿性心脏病次之，先天性心脏病较差。如存在严重机械因素，应积极再次手术。     

主动脉内气囊反搏在冠心病外科的应用(摘要)

主动脉内气囊反搏在冠心病外科的应用（摘要）龚庆成高泉鑫１材料与方法选自１９８５年３月至１９９６年１２月的１２例患者，经冠心病手术围术期发生低心输出量，应用主动脉内气囊反搏（ＩＡＢＰ）辅助抢救，其中男１０例，女２例，年龄４７～６１岁。１２例中７例（５...     

出血性脑卒中术后高血压危象若干血管活性物质变化研究的机制探讨

目的：分析血管活性物质在高血压出血性脑卒中术后高血压危象中的作用。方法：将２２例高血压脑出血患者分为高血压出血性脑卒中术后高血压危象组（Ａ组）９例，高血压出血性脑卒中术后无高血压危象组（Ｂ组）１３例。以同期非出血性脑卒中的颅脑手术患者作为对照组（Ｃ组）９例，分别测定几种血管活性物质含量或活性。结果：①Ａ组患者内皮素、凝血烷Ｂ２（血栓素Ｂ２，ＴＸＢ２）、前列环素（ＰＧＩ２）和去甲肾上腺素的含量及ＴＸＢ２／ＰＧＩ２明显高于Ｂ、Ｃ组患者。②Ａ组患者去甲肾上腺素术后明显高于术前，Ｐ＜００１。结论：ＴＸＢ２／ＰＧＩ２值增加以及内皮素、去甲肾上腺素的含量增高对术后高血压危象的发生有一定作用     

前列腺增生症患者手术前后TxA_2、PGI_2的变化及其与心血管并发症的关系

测定２０例良性前列腺增生症（ＢＰＨ）患者前列腺手术前后血浆ＴｘＡ２和ＰＧＩ２及其比值的动态变化，并将其中伴有冠心病和无冠心病分组进行对比。结果表明，ＢＰＨ患者术后ＰＧＩ２明显下降（Ｐ＜０．０５），ＴｘＡ２／ＰＧＩ２比值升高，术后２周基本恢复至术前水平。伴冠心病者术后不仅ＰＧＩ２明显降低，且ＴｘＡ２显著增高（Ｐ＜０．０５），ＴｘＡ２／ＰＧＩ２比值明显升高，术后２周未能下降到术前水平。提示在ＢＰＨ切除术后心肌缺血和心脏猝死的发生与血浆ＴｘＡ２和ＰＧＩ２及其比例失调有关。     

前列腺增生症患者手术前后TxA2,PGI2的变化及其与心血管…

测定２０例良性前列腺增生症（ＢＰＨ）患者前列腺手术前后血浆ＴｘＡ２和ＰＧＩ２及其比值的动态变化，并将其中伴有冠心病和无冠心病分组进行对比。结果表明，ＢＰＨ患者术ＰＧＩ２有显下降（Ｐ＜０．０５），ＴｘＡ２／ＰＧＩ２比值升高，术后２周基本恢复至是水平，伴冠心病者术后不仅ＰＧＩ２明显降低，且ＴｘＡ２显著增高（Ｐ＜０．０５），ＴｘＡ２／ＰＧＩ２比值明显升高，术后２周未能下降到术前水平，提示在ＢＰＨ切除术后     

不同起搏方式对病窦综合征患者远期效果的影响

为了解不同起搏方式对病窦综合征特别是慢－快综合征患者心功能及房性心律失常的影响，利用超声心动图、体表心电图及Ｈｏｌｔｅｒ检查，对２１１例病窦综合征患者采用自身对照方法进行回顾性分析。结果发现：生理性起搏（ＡＡＩ／ＤＤＤ）组术后左室射血分数（ＬＶＥＦ）、心输出量（ＣＯ）明显增加（ＡＡＩ：５３．５±６．１％ｖｓ４７．２±７．８％，４．９５±０．５７Ｌ／ｍｉｎｖｓ４．２０±０．６２Ｌ／ｍｉｎ；ＤＤＤ：５２．５±６．８％ｖｓ４４．３±０．１％，５．１２±０．７１Ｌ／ｍｉｎｖｓ４．４１±０．３８Ｌ／ｍｉｎ；Ｐ均＜０．０１），左房内径（ＬＡＤ）无明显变化；ＤＤＤ组Ｅ／Ａ比值明显增加（０．９８±０．０９ｖｓ０．８７±０．１５，Ｐ＜０．０１），ＡＡＩ组Ｅ／Ａ比值呈增加趋势（Ｐ＝０．０５７）。房性心律失常发生率明显减少（１５．９％ｖｓ５０％，Ｐ＜０．０１）。非生理性起搏（ＶＶＩ）组术后ＬＶＥＦ、ＣＯ明显下降（４４．１±４．７％ｖｓ４８．３±４．３％，３．７７±０．４２Ｌ／ｍｉｎｖｓ４．１７±０．８５Ｌ／ｍｉｎ，Ｐ均＜０．０１），ＬＡＤ明显增大（３９．２６±２．３７ｍｍｖｓ３６．８１±２．３５ｍｍ，Ｐ＜０．０１），Ｅ／Ａ比值呈?     

容量负荷对慢性心力衰竭患者心功能评价的意义

采用Ｓｗａｎ－Ｇａｎｚ导管对２６例慢性心力衰竭（ＣＨＦ）患者容量负荷前后的血流动力学变化进行监测，结果表明：①随心功能恶化，右房压（ＲＡＰ）和肺毛细血管楔压（ＰＣＷＰ）升高，心脏指数（ＣＩ）下降。②负荷后ＲＡＰ和ＰＣＷＰ升高，３０分钟达高峰，大多数于２小时内恢复；ＣＩ则反应不一。③负荷后ＰＣＷＰ、ＣＩ峰值与心输出量贮备指数（ＣＯＲＦ）密切相关。提示ＰＣＷＰ和ＣＩ是判定心功能的可靠指标，其变化幅度能比较客观地反映心衰程度；容量负荷后的ＰＣＷＰ、ＣＩ变化也有助于准确评估ＣＨＦ患者的心脏贮备能力。     

急性心肌梗塞并高血压患者近期预后

探讨高血压对急性心肌梗塞（ＡＭＩ）患者近期预后的影响。方法７７例经监护病房确诊的ＡＭＩ患者，按是否合并高血压分为Ａ组（合并组４１例）和Ｂ组（不合并组３６例），对比分析其梗塞前左室肥大发生率、住院期间并发症及死亡率。结果左室肥大发生率：Ａ组７３．２％，Ｂ组２２．２％；梗塞后Ａ／Ｅ值增高：Ａ组１．７５±０．４３，Ｂ组１．１５±０．４８；泵衰竭发生率：Α组３１．７％，Β组５．６％。以上三项Α组均高于Β组，有非常显著差异（Ｐ＜０．０１）。左室重塑发生率及死亡率：Α组（４３．９％及３１．７％）高于Β组（１９．４％及１１．１％），有显著差异（Ｐ＜０．０５）。梗塞扩展发生率及严重心律失常发生率Ａ组高于Ｂ组，但无统计学差异。结论Α组近期预后比Β组差，提示高血压是影响ＡＭＩ预后的一个高危因素。     

体外循环时凝血噁烷A_2的变化

的：研究体外循环（ＣＰＢ）时凝血烷Ａ２（血栓素Ａ２，ＴＸＡ２）的变化。方法：２０例非紫绀型先天性心脏病患者，在ＣＰＢ开始５分钟，主动脉开放即刻，主动脉开放后５分钟、１０分钟、２０分钟及停ＣＰＢ时分别行动脉血和静脉血白细胞计数及ＴＸＡ２含量测定。结果：①主动脉开放后５分钟、１０分钟，动脉血白细胞计数显著低于静脉血（Ｐ＜０．０５），主动脉开放前、主动脉开放后２０分钟、停ＣＰＢ时，两者无显著差异。②ＴＸＡ２于主动脉开放后开始升高，１０分钟达峰值，后逐渐下降，但停ＣＰＢ时仍高于术前（Ｐ＜０．０５）；动脉血ＴＸＡ２含量于主动脉开放后５分钟、１０分钟均显著高于静脉血（Ｐ＜０．０５）。结论：①肺脏是ＣＰＢ期间ＴＸＡ２的主要来源之一，可能与肺脏大量白细胞隔离有关。②显著升高的ＴＸＡ２可能与ＣＰＢ肺脏损伤及术后右心功能障碍有关     

二维超声观察AAI与VVI起搏前后血流动力学的变化

作者对２３例安装永久性起搏器患者，采用二维超声，比较起搏器植入前后血流动力学的变化。结果显示；植入后心房按需起搏（ＡＡＩ）组和心室按需起博（ＶＶＩ０组的心排血量均明显增加（Ｐ〈０．０５），分别增加４０．６％和２１．２％，但植入后ＶＶＩ组在左室射血分散，每搏量，左室舒张末期容积均降低（Ｐ〈０．０５），ＡＡＩ组无变化。研究表明ＡＡＩ生理性起搏对于中层得血流动力学的改善优于ＶＶＩ非生理性起搏，心排血量是     

Intraaortic balloon counterpulsation: an eleven-year review and analysis of determinants of survival

During an 11-year period ending January 1, 1985, 352 patients had insertions of an intraaortic balloon pump (IABP) as an adjunct to medical or surgical therapy. Group I, 175 patients, could not be weaned from cardiopulmonary bypass and required intraaortic balloon pump (IABP). Thirty-nine patients (22%) died in the operating room. Twenty-five patients (14%) died in the acute care unit. The remaining 111 patients (63.4%) survived and were discharged from the hospital. Group II, 104 patients, had the IABP inserted preoperatively. Indications were: postinfarction cardiogenic shock (34 patients), unstable angina (35), postinfarction angina (27), poor ventricular function (six), and prophylaxis (two). Of the 62 patients with unstable angina and postinfarction angina, 57 (92%) were successfully weaned. Of the 34 patients with postinfarction cardiogenic shock, 26 were weaned, but only 16 (47%) survived to leave the hospital. Group III, 34 patients, had the IABP inserted for postoperative hemodynamic deterioration in the acute care unit at variable times: 14 (41%) patients survived. Group IV, 39 patients, had IABP support for medical therapy. Of 24 patients with postinfarction cardiogenic shock, 12 survived. Twelve of 13 patients with unstable angina lived. Of the 352 patients, 228 (65%) were discharged from the hospital. The overall incidence of complications was 12.5%. Complications related to IABP were higher with percutaneous insertion than by femoral arteriotomy (15% vs 12%). Intraaortic balloon counterpulsation effectively unloads the failing left ventricle in weaning patients from cardiopulmonary bypass (Group I). Preoperative insertion (Group II) resulted in 92% survival in patients with both pre- and postinfarction angina. Delayed insertion (Group III) in postoperative patients gave the poorest survival (41%). In patients with postinfarction cardiogenic shock, IABP without corrective cardiac surgery was associated with a 50% survival: with corrective cardiac surgery, 16 patients (47%) survived. Left ventricular dysfunction, myocardial infarction, and timely insertion of IABP are the primary determinants of survival. Approximately one-third of patients who required IABP will die. More involved techniques for mechanical support of the failing circulation, such as ventricular assist device or total artificial heart, may increase survival.     

Coronary angioplasty in high risk patients: comparison of elective intraaortic balloon pump and percutaneous cardiopulmonary bypass support--a randomized study

Forty patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with severely impaired left ventricular ejection fraction (LVEF) < 30% were randomized between prophylactic intraaortic balloon pump (IABP) support (N = 20) and percutaneous cardiopulmonary bypass (PCPB) support (N = 20). The indications for both groups were left ventricular (LV) dysfunction and a large area of myocardium (> 50%) being perfused by the target vessel. The IABP and PCPB supported groups were comparable in LVEF (20% +/- 6.4% vs 22.8% +/- 8.1%), mean pulmonary artery pressure (46.5 +/- 10.5 mmHg vs 42.6 +/- 12.6 mmHg), average number of vessels dilated (1.4 vs 1.3), mean inflation time (2.8 +/- 0.3 min vs 3.1 +/- 0.5 min), and hospital stay after PTCA (5.6 +/- 1.2 days vs 5.2 +/- 1.4 days). The primary success rate (95% vs 95%) and hospital mortality (5% vs 5%) were also similar in the two groups. Two patients required surgical exploration of the femoral artery and eight patients required blood transfusion in the PCPB group. IABP patients had no vascular complications and did not require blood transfusion. High risk PTCA is equally effective whether using prophylactic IABP or PCPB support. PCPB support, however, has a higher rate of vascular complications and need for blood transfusions. IABP has the additional advantage of ease of insertion and the support can be used for a longer period after PTCA, if required.     

Prophylactic use of the intra-aortic balloon pump in high-risk cardiac patients undergoing noncardiac surgery: a decision analytic view.

OBJECTIVE: As the indications for the intra-aortic balloon pump (IABP) continue to evolve, a potential new use may be the prophylactic preoperative insertion of the IABP in the high-risk cardiac patient undergoing noncardiac surgery. Our objective is to present a general approach to the high-risk cardiac patient who may benefit from the prophylactic insertion of the IABP. DESIGN: Case reports and a decision analysis. METHODS: A decision model was constructed that weighs the risk of life-threatening postoperative complications against the risk of vascular complications, including surgery and possible amputation, from IABP insertion. RESULTS AND CONCLUSIONS: A review of the literature identified 10 patients who underwent IABP placement prior to noncardiac surgery. These patients, along with our three cases, define a population of patients for whom the prophylactic IABP may be useful. This population includes patients with coronary artery disease (CAD) for whom bypass grafting is not an option due to: (1) inoperable CAD; (2) a severe coexisting disease process (such as a malignancy); or (3) the emergent nature of the noncardiac procedure. The decision analysis suggests that patients whose preoperative assessment places them at very high risk for postoperative complications (Goldman class IV or Detsky class III undergoing major surgery) may benefit the most from prophylactic placement of an IABP prior to noncardiac surgery.     

Current role of intra-aortic diastolic balloon counterpulsation in heart surgery]

Intra-aortic balloon counterpulsation (IABP) is a relatively non-invasive method of circulating assistance, easy to use and which has benefitted from a number of technological improvements in recent years. This retrospective study over 4 years was undertaken to analyse the results of IABP and to determine its role in therapeutic arsenal against cardiac failure. Sixty five patients, 57 coronary and 8 valvular cases, with an average age of 61 +/- 10 years were included. The indications of IABP were: a bridge to transplantation (3 cases), complications of coronary angioplasty (4 cases), and low cardiac output after cardiopulmonary bypass (58 cases), where IABP was curative in 85% of cases and prophylactic in 15% of cases (patients with risk factors of low output state after CPB). Beforehand, 65% of patients had poor left ventricular function (LVEF < 40% and/or CI < 2.2 l/mn/m2). An Aries Medical M700 console was used. The percutaneous femoral approach was feasible in 87% of cases. The results were: improvement with discharge from intensive care unit in 60% of cases, transient improvement in 7% of cases, no improvement in 15% of cases and cardiac transplantation in 8% of cases. The outcome was worse when the preoperative LV function was poor and when high dose inotropic agents had to be used. Survival was 100% in those patients in whom IABP was a prophylactic measure. The average duration of IABP was 72 hours, survival being significantly lower in those in whom IABP was continued for over 3 days. The complications (12.7%) were thromboembolic.(ABSTRACT TRUNCATED AT 250 WORDS)     

左西孟旦对冠状动脉旁路移植术术后因左心功能不全应用主动脉内球囊反搏患者预后影响

目的 探讨左西孟旦对冠状动脉旁路移植术术后因左心功能不全应用主动脉内球囊反搏(IABP)患者的影响.方法 收集2017年1月至2019年4月泰达国际心血管病医院心脏大血管外科患者术后因左心功能不全应用IABP的112例患者的临床资料,并以应用"左西孟旦"为分组变量建立倾向匹配44对病例资料,比较两组术后住院时间、呼吸机...     

预防性置入主动脉内球囊反搏应用于高危冠心病患者行冠状动脉旁路移植术临床疗效分析

目的 探讨预防性置入主动脉内球囊反搏（Intra-aortic balloon pump ,IABP)在高危冠心病患者接受冠状动脉旁路移植术（Coronary artery bypass graft,CABG）中的临床疗效。方法 回顾并总结我院2013年01月-2020年06月175例CABG围术期行IABP置入术患者的临床资料,术前平均年龄（61.2±9.2）岁,其中男性131人（74.9%）。根据IABP置入时机分为预防性置入组（术前置入IABP）（n=66）和对照组（术中或术后置入IABP）（n=109）,对比分析两组患者临床资料。结果 两组患者一般基线资料差异无统计学意义（P>0.05）。与对照组相比,预防性置入组IABP支持时间（h,107.5±68.3 vs 130.4±72.6）,机械通气时间（h,76.9±82.1 vs 129.6±160.5）,ICU监护时间（h,145.9±99.9 vs 196.4±180.5）显著减少（P?0.05）。术后急性肾损伤（13.6% vs 28.4%）、低心排量综合征（0 vs 6.4%）、多器官功能衰竭（0 vs 7.3%）发生率降低,差异有统计学意义（P?0.05）。预防性置入组围术期死亡率（10.6%）低于对照组（22.9%）,差异有统计学意义（P?0.05）。结论 对于接受CABG治疗的高危冠心病患者,术前预防性置入IABP可降低患者围术期死亡率,降低术后急性肾损伤、低心排量综合征、多器官功能衰竭发生率,缩短IABP支持时间、机械通气时间、ICU监护时间。     

Mechanical control of circulation: clinical results with intra-aortic balloon pumping and veno-arterial bypass in left and/or right cardiac failure

Eighty-seven cases were studied in which IABP was used with open heart surgery, and 19 in which V-A bypass was employed. IABP was used in 31 patients with ischemic heart disease, which had the best survival rate (52%). Recent experience shows that the effects of IABP increase the operability of certain high-risk patients with severely impaired left ventricular function. In valvular heart disease, IABP was used with a survival rate of 34%. In congenital heart disease, the IABP survival rate was the worst among the groups studied because, in addition to left heart failure, many other factors also as cause the low cardiac output syndrome during corrective surgery for complicated cardiac anomalies. In total right heart bypass, or Fontan's procedure, three out of five cases were weaned from IABP; one of them is still alive. IABP was used with success in one case of valvular heart disease with almost no contraction of the right ventricle after repair. Therefore, IABP could be expected to improve the condition of severe postoperative right heart failure, or the equivalent condition, when there is subnormal left ventricular function in the postoperative period and pulmonary vascular resistance is normal. There has been only one successful V-A bypass lasting 11 hours, in valvular heart disease, and another case, in congenital heart disease, where the patient was weaned after V-A bypass lasting four days.     

非体外循环冠状动脉旁路移植术在左心室功能低下患者中的应用

目的:分析左心室功能低下(EF<40%)冠心病患者,接受非体外循环冠状动脉旁路移植手术(OPCAB)的疗效,改进左心室功能低下冠心病患者的治疗策略。方法:回顾性分析2006年以来我院手术组对37例左心室功能低下的冠心病患者,行OPCAB后手术前后疗效的对比。结果:2例患者死亡,1例死于术后肺部感染,1例死于术后低心排出量综合征(低心排),病死率5%。21例患者使用主动脉内球囊反搏器(IABP),其中7例在术前放置,14例在术中或术后放置。35例患者术后左心室射血分数(EF值)较术前有明显改善(P<0.05);左心室舒张末期内径、左心室收缩末径均较术前下降(P<0.05)。结论:对于左心室功能低下的冠心病患者,OPCAB是一种有效的治疗方法。及时使用主动脉球囊反搏,以及合理应用正性肌力药物对于降低患者病死率,减少患者住院时间具有重要意义。     

Use of intraaortic balloon counter pulsation in a patient with tortuous aorta

The intraaortic balloon pulsation (IABP) catheter is commonly used to treat left ventricular failure. The abnormality of the descending thoracic and abdominal aorta is considered as a relative contraindication for its insertion. We present here a patient with acute myocardial infarction with a post-infarct ventricular septal defect who presented with left ventricular failure. During coronary angiography, tortuous abdominal aorta was noted and IABP catheter was inserted under fluoroscopic guidance to support the cardiovascular system. This case is reported to encourage discussion on the use of IABP catheters in patients with tortuous aorta and avoidance of events described.