心室辅助装置的临床管理

目的 探讨心室辅助装置临床应用中的管理要点。方法 2001．1～2002．12共有6例患者行心室辅助装置植入术。其中终末期扩张性心肌病合并心衰4例(1例术前2次心搏骤停)，肥厚性心肌病多次心搏骤停1例，急性大面积心梗并心源性休克1例。4例植入Berlin—Heart人工心脏，其中1例为永久植入型，余为体外气动隔膜型；另2例植入Me—dos心室辅助装置；6例患者中行双心室辅助1例，其余5例为左心辅助。术后采用四联抗凝治疗，专人定时密切监测心室辅助装置血泵和主机工作情况，及时调整各项参数。结果 本组所有患者术后心功能均得到明显改善。其中4例术后可携心室辅助装置自由活动。全部病例中有2例患者于术后心功能基本恢复并成功撤除人工心脏康复出院，1例患者携带人工心脏出院。死亡2例中，1例因术前出现多器官功能不全，术后虽然血流动力学有所改善，但终因严重肝肾功能衰竭于第l0d死亡。另一例患者因凝血功能异常术后并发严重的免疫性溶血于术后第12d死亡。心室辅助装置工作期间无机械故障发生。结论 心室辅助装置作为终末期心衰患者心脏移植前的过渡治疗或作为长期应用以促进心肌功能的恢复，其作用显著。在应用过程中应加强对心室辅助装置系统的各项管理，使其在长期的临床应用中更为安全，有效。

The Clinical Management of Ventricular Assist Device

OBJECTIVE Discuss the management in clinical application of ventricular assist device(VAD). METHODS From January 2001 to December 2002, 6 patients were implanted VAD. 4 patients with dilated cardiomyopathy: one with hypertrophic cardiomyopathy and cardiac arrest; one with acute myocardial infarction. Five patients were implanted LVAD, which included one DVAD. Five patients whch included one implantable LVAD were used extracorporeal blood pumps. RESULTS Cardiac function was improved significantly after VAD. Two weaned from VAD successfully. One patient with LVAD was discharged from hospital.CONCLUSION Use of VAD as a bridge to transplant for end-stage heart failure can improve cardiac function and the quality of life. To make the VAD use safe and efficient, the management in perioperation should be very important.