心脏瓣膜病术后低心排血量综合征的临床研究-内科急危重症.doc

主动脉球囊反搏联合血液净化治疗心脏瓣膜病术后心源性休克的临床研究 肖红艳 刘彬 危宇 李颖 任海波 武汉亚洲心脏病医院ICU 430022，武汉市京汉大道753号E-mail:172850070@ 通讯作者：刘彬，Email: liubin0216@ 摘 要 目的 探讨主动脉球囊反搏（intro-aortic balloon pump，IABP）联合血液净化（continuous blood purification， CBP）在心脏瓣膜病术后心源性休克治疗中的作用。 方法：回顾性分析60例在我院行心脏瓣膜置换术后发生心源性休克的病例，统计IABP和CBP联合辅助治疗组（联合组）和单纯CBP组（CBP组）的临床资料，对比分析两组的临床治疗效果及临床预后。结果：CBP能有效的减轻心脏的前负荷，纠正乳酸酸中毒，应用IABP联合CBP治疗能更有效的改善血流动力学，使平均动脉压、左室射血分数、混合静脉血氧饱和度得到有效改善，减少血管活性药物用量及室性心律失常，相比较于单纯CBP治疗组有显著差异（P 0.05）；在总的机械通气时间、住院时间、住ICU时间、ICU 病死率联合组均优于单纯CBP组（P 0.05）。结论：对于瓣膜病术后药物治疗无效的心源性休克，IABP 联合CBP治疗能显著的降低左室的前负荷，提高平均动脉压，改善冠脉供血，纠正内环境紊乱，延缓MODS的病程进展，改善预后。 关键词：心脏瓣膜病术后，心源性休克，主动脉球囊反搏，血液净化。? The clinical research of intro-aortic balloon pump with blood purification therapy of cardiac shock in postoperative heart valve disease Xiao Hongyan, Liu Bin, Li Ying, Wei Yu, Ren Haibo. Department of Intensive Care Unit, Wuhan Aisa Heart Hospital, Wuhan 430022, Hubei, China Corresponding author: Liu Bin, Email: liubin0216@ Abstracts: objective?: To?assess?the clinical?effect?of?intra-aortic?balloon pump?and continuous blood purification in?patients?with cardiogenic?shock?after?cardiac?valve?replacement.? Methods:We?analyzedretrospectively?clinical?data?of?60??patients?with cardiogenic?shock?after?cardiac?valve?replacement., these?cases?were divided into?2?groups,?IABP with CBP group?and?pure CBP?group,?and?the outcome?were analyzed for each group.? Results:The CBP ?is?effective?in?decreasing?cardiac?preload and lactic acidosis. Application of IABP with CBP therapy can effectively improve hemodynamics, the mean arterial pressure, left ventricular ejection fraction, mixed venous oxygen saturation, and also reduce vascular active drug dosage and ventricular arrhythmia, compared with pure CBP treatment group (P 0.05); The combination group were superior to pure CBP group (P 0.05), in the total mechanical ventilation time , length of hospital stay, ICU time, ICU mortality. Conclusion: ?To the