心脏外科围术期应用主动脉内球囊反搏的并发症及危险因素分析

目的分析心脏外科手术围术期应用主动脉内球囊反搏(IABP)辅助治疗后并发症的发生情况及高危因素。 方法回顾分析本院2011年1月至2016年12月心脏外科实施手术置入IABP患者80例，根据IABP置入后并发症发生情况分为研究组(12例)、无并发症组(68例)，收集患者一般资料、术前合并症、围手术期情况、IABP置入相关情况以及IABP相关并发症发生情况等，通过回归分析进行相关性分析。 结果两组在性别、年龄、体质量指数、高血压、脑卒中发生率等方面比较差异无统计学意义(P>0.05)，在65岁以上患者、糖尿病发生率、外周血管病发生率及体外膜肺氧合应用率方面差异有统计学意义(P<0.05)。IABP置入并发症发生危险因素为高龄患者(65岁以上)、糖尿病、外周血管病及体外膜肺氧合。研究组65岁以上患者比例(83.33%)、糖尿病发生率(41.67%)、外周血管病发生率(66.67%)及体外膜肺氧合应用率(41.67%)均显著高于无并发症组，两组IABP辅助时间及置入时机差异无统计学意义(P>0.05)。两组患者治疗后平均动脉压、尿量均显著升高，中心静脉压、心率、多巴胺、肾上腺素显著降低，差异有统计学意义(P<0.05)。纳入研究患者，术前置入26例，术中置入35例，术后置入19例，并发症发生率为7.69%、11.43%、31.58%。置入后出血7例(8.75%)，缺血2例(2.50%)，其中坏疽1例，骨筋膜室综合症1例，血管损伤2例，IABP置入失效1例。 结论置入IABP相关并发症发生率较低，穿刺部位局部出血及肢体缺血是临床常见并发症，高龄、糖尿病、周围血管病及体外膜肺氧合辅助治疗是IABP并发症发生的独立危险因素。临床应用中应加强围术期护理监护，规范操作流程以减少并发症发生。

Analysis of complications and related factors of intra aortic balloon counterpulsation in the perioperative period of cardiac surgery

ObjectiveTo explore and analyze the incidence and risk factors of complications in the perioperative period of aortic balloon counterpulsation (IABP) in the perioperative period of cardiac surgery. MethodsFrom January 2011 to December 2016, a retrospective analysis of 80 patients with IABP who underwent cardiac surgery from January 2011 to December 2016 was divided into study group (12 cases) and non-complication group (68 cases) according to the incidence of complications after IABP implantation. General information, preoperative complications, perioperative conditions, IABP placement and IABP related complications were collected, and correlation analysis was done by regression analysis. ResultsThere were no significant differences in gender, age, body mass index, hypertension, and stroke incidence between the two groups (P>0.05). There were significant differences in the percentage of patients over 65 years old, the incidence of diabetes, the incidence of peripheral vascular disease and rate of application of in vitro membrane oxygenation (P<0.05). The risk factors of IABP implantation complication were elderly patients (65 years old), diabetes, peripheral vascular disease and extracorporeal membrane oxygenation. In the study group, the proportion of patients over the age of 65 years(83.33%), the incidence rate of diabetes (41.67%), peripheral vascular disease incidence rate (66.67%) and the application of the extracorporeal membrane oxygenation rate (41.67%) were significantly higher than that in non-complication group. There were no significant differences in the auxiliary time of IABP and the timing of placement between the two groups (P>0.05). The mean arterial pressure and urine volume of the two groups were significantly increased after treatment, and the central venous pressure, heart rate, dopamine and epinephrine were decreased significantly and the difference were statistically significant (P < 0.05). 26 patients underwent preoperative placement, 35 patients underwent intraoperative placement, and 19 patients underwent postoperative complication. The complication rates were 7.69%, 11.43%, and 31.58%, respectively. There were 7 cases (8.75%) after hemorrhage and 2 cases (2.50%) with ischemia, including 1 case of gangrene, 1 case of compartment syndrome, 2 cases of vascular injury, and 1 case of IABP failure. ConclusionThe results of this study confirm that the incidence of complications associated with IABP is low . Local bleeding and limb ischemia are common clinical complications. Advanced age, diabetes, peripheral vascular disease and extracorporeal membrane oxygenation are independent risk factors for IABP complications. In clinical application, perioperative nursing care can be strengthened and operation process can be standardized to reduce the incidence of complications.