主动脉球囊反搏在急诊冠脉搭桥术中的应用-第三军医大学学报.DOC

主动脉球囊反搏在急诊冠状动脉搭桥术前的应用 杨传瑞，张 勇，冯文会，李大连，程智广，郭建中，陈绪军 (首都医科大学附属北京友谊医院心脏中心心血管外科，北京 100050) 摘 要：目的 回顾我院主动脉球囊反搏（intra aortic balloon pump，IABP）在急诊冠状动脉搭桥术中应用的临床经验，探讨应用IABP的时机选择和适应证。方法 总结31例冠心病患者在IABP支持下，实施急诊冠状动脉旁路移植术的情况。结果 患者均成功拔出，29例恢复良好，痊愈出院。结论 急诊冠状动脉旁路移植术风险较大，在术前应用IABP可以有效改善心功能，提高手术成功率，确保乳内动脉的使用。 关键词：主动脉球囊反搏；冠脉搭桥术；乳内动脉 中图法分类号： 文献标识码：A Application of intra aortic balloon pump before emergency coronary artery bypass grafting: report of 31 patients of coronary heart disease YANG Chuan-rui, ZHANG Yong, FENG Wen-hui, LI Da-lian, CHENG Zhi-guang, GUO Jian-zhong, CHEN Xu-jun (Department of Cardiovascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China) Abstract：Objective To review the clinical experience and application of intra aortic ballon pump (IABP) in the patients needing emergency coronary artery bypass grafting (eCABG) and explore the proper time and indications of the counterpulsation. Methods Totally 31 cases who receiving IABP before eCABG from March 2000 to August 2008 were subjected. IABP catheter was placed through the internal femoral to artery, and continuously measurement of hemodynamic parameters, including continuous cardiac output (CCO), cardiac index (CI), systolic arterial blood pressure (SABP), mean arterial blood pressure (MABP), and pulmonary capillary wedge pressure (PCWP) during perioperative period were performed. eCABG was carried out on 15 patients with cardiopulmonary bypass and 16 with off-pump. Results Twenty-nine patients were survival, and 2 patients died of multiorgan failure due to long term tracheal incubation. The duration of the IABP assist ranged from 20 to 109 h, with a mean of (32.8±16.9) h. All patients were removed IABP successfully. With the IABP treatment, the CCO, CI, SABP and MABP were significantly increased (P0.05), while PCWP was declined (P0.05). Conclusion IABP can effectively improve the hemodynamic status of patients, and installing IABP before the eC