摘要
目的探讨重症心脏疾病术后患者应用主动脉内球囊反搏(intraaortic balloon counterppulsation,IABP)治疗时机对临床疗效的影响。方法选取2018年3月至2020年3月广东省高州市人民医院心脏术后应用IABP患者64例进行前瞻性研究,根据患者实施IABP治疗时间分为早期治疗组33例(重症心脏术后<6 h)与晚期治疗组31例(重症心脏术后≥6 h):观察两组患者平均动脉压(mean arterial pressure,MAP)、左心室射血分数(left ventricular ejection fraction,LVEF)、机械通气时间、IABP留置时间、ICU停留时间、中心静脉血氧饱和度(central venous oxygen saturation,ScvO2)、氨基末端脑钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)、乳酸清除率、并发症及随访情况。结果IABP 48 h后,早期治疗组患者MAP为(79.47±7.07)mmHg、LVEF为(45.20±3.86)%,晚期治疗组分别为(71.38±6.26)mmHg、(41.66±4.49)%,两组比较差异均有统计学意义(t值分别为34.604、29.375,P均<0.01)。早期治疗组机械通气时间为(71.56±5.98)h、IABP留置时间为(68.31±10.10)h、ICU停留时间为(5.84±1.04)d,晚期治疗组分别为(82.79±4.96)h、(89.49±9.97)h、(6.82±1.07)d,两组比较差异均有统计学意义(t值分别为70.093、72.855、31.859,P均<0.01)。IABP 48 h后,早期治疗组ScvO2为(71.66±5.45)%、NT-pro BNP为(1698.36±1032.98)ng/L、乳酸清除率为(30.12±2.29)%,晚期治疗组分别为(66.03±4.61)%、(2898.43±1383.29)ng/L、(20.47±1.92)%,两组比较差异均有统计学意义(P均<0.01)。早期治疗组并发症发生率为18.18%(6/33),晚期治疗组为41.94%(13/31),两组比较差异有统计学意义(P=0.038)。结论早期使用IABP治疗能够改善患者血流动力学与血清学指标、降低患者机械通气时间、IABP时间、ICU监护时间及并发症。
Objective To investigate the effect of the timing of intra-aortic balloon counterpulsation(IABP)treatment on the clinical efficacy of patients after severe cardiac surgery.Methods A prospective study was conducted on 64 patients with IABP after cardiac surgery in Gaozhou People′s Hospital of Guangdong Province from March 2018 to March 2020.According to the time of IABP treatment,33 patients were divided into early treatment group(severe cardiac surgery<6 h)and late 31 cases in treatment group(≥6 h after severe cardiac surgery):two groups of mean arterial pressure(MAP),left ventricular ejection fraction(LVEF),mechanical ventilation time,IABP indwelling time,ICU stay time,central venous oxygen saturation(ScvO2),N terminal pro B type natriuretic peptide(NT-proBNP),lactate clearance rate,complications and follow-up.Results After 48 hours of IABP,MAP and LVEF in the early treatment group were(79.47±7.07)mmHg and(45.20±3.86)%,respectively,and those in the late treatment group were(71.38±6.26)mmHg and(41.66±4.49)%.There were significant differences between the two groups(t value was 34.604,29.375 respectively all P<0.01).The mechanical ventilation time(71.56±5.98)h,IABP indwelling time(68.31±10.10)h,ICU stay time(5.84±1.04)d in the early treatment group,and those in the late treatment group(82.79±4.96)h,(89.49±9.97)h,(6.82±1.07)d.There were significant differences between the two groups(t value was 70.093,72.855,31.859 respectively,all P<0.01).The ScvO2,NT-pro BNP and lactate clearance rate in the early treatment group were(71.66±5.45)%,(1698.36±1032.98)ng/L and(30.12±2.29)%,respectively at 48 hours after IABP,and those in the late treatment group(66.03±4.61)%,(2898.43±1383.29)ng/L and(20.47±1.92)%.There were significant differences between the two groups(t value was 38.279,34.379 respectively,all P<0.01).The incidence of complications were 18%(6/33)and 41.94%(13/31)in the early treatment group and the late treatment group.There was significant difference between the two groups(P=0.038).Conclusion Early use of IABP treatment can improve the patients′hemodynamic and serological indicators,reduce the patient′s mechanical ventilation time,IABP time,ICU monitoring time and complications.
作者
黄伟
程国栋
朱春磊
李小芳
张金明
袁权富
Huang Wei;Cheng Guodong;Zhu Chunlei;Li Xiaofang;Zhang Jinming;Yuan Quanfu(Department of Critical Care,Gaozhou People′s Hospital,Guangdong Province,Gaozhou 525200)
出处
《中国综合临床》
2021年第2期166-170,共5页
Clinical Medicine of China
基金
茂名市科技计划项目(2018297)。
关键词
重症心脏疾病
主动脉内球囊反搏治疗
时机选择
并发症
预后
Severe heart disease
Intra-aortic balloon counterpulsation therapy
Timing selection
Complication
Prognosis
