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find Keyword "主动脉内球囊反搏" 18 results
  • Application of Intra-aortic Balloon Pump for High-risk Patients before Off-pump Coronary Artery Bypass Grafting

    Abstract: Objective To analyze clinical outcomes of intra-aortic balloon pump (IABP) application for high-risk  patients before undergoing off-pump coronary artery bypass grafting (OPCAB), and summarize our experience and weaning indications of IABP. Methods We retrospectively analyzed clinical data of 102 high-risk patients with coronary artery disease who underwent IABP implantation before OPCAB from January 2008 to July 2011 in Zhongshan Hospital of Fudan University. There were 71 male patients and 31 female patients with their average age of 63.0±8.2 years in this IABP group. We also chose another 100 patients without IABP implantation before undergoing OPCAB as the control group, including 55 male patients and 45 female patients with their average age of 64.1±9.5 years. Postoperative systolic arterial blood pressure (SABP), mean arterial blood pressure (MABP), mechanical ventilation time, length of intensive care unit(ICU) stay, morbidity, duration of IABP treatment and in-hospital mortality of two groups were compared. Left ventricular  ejection fraction (LVEF) was evaluated with echocardiography 3 months after surgery. Results Postoperative SABP (95.3±12.2 mm Hg vs. 80.1±11.7 mm Hg;t=8.440, P=0.000) and MABP (78.9±13.5 mm Hg vs. 52.3±15.1 mm Hg; t=12.410, P=0.000) of the IABP group were significantly higher than those of the control group. Mechanical ventilation time, length of ICU stay and duration of inotropic support of the IABP group were significantly shorter than those of the control group. The incidence of ventricular arrhythmia, low cardiac output syndrome, perioperative myocardial infarction and dialysis-requiring acute kidney failure of the IABP group were significantly lower than those of the control group. In-hospital mortality of the IABP group was significantly lower than that of the control group [5.9% (6/102) vs. 17.0% (17/100), χ 2 =6.180, P=0.020]. Ninety-six patients in the IABP group and 83 patients in the control group were followed up for 3 months. Three months after surgery, echocardiography showed that LVEF of the IABP group was significantly higher than that of the control group(45.3%±12.0% vs. 39.1%±8.2%, t=3.950, P=0.000). Conclusion Preoperative prophylactic IABP implantation and optimal timing of weaning from IABP support can not only significantly reduce surgical risk and improve surgical outcomes and postoperative recovery of high-risk patients undergoing OPCAB, but also considerably ameliorate patient heart function and reduce perioperative morbidity and mortality.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 新型主动脉旁与主动脉内球囊反搏对羊重度急性心力衰竭辅助的实验研究

    Objective To compare the assisting function between a new paraaortic counterpulsation device (PACD) and the intraaortic balloon pump (IABP) in acute severe heart failure in sheep. Methods Eight healthy adult small fattailed sheep were chosen in our study. The selfmade PACD (with a stroke volume of 55 ml) was anastomosed to the descending aorta through a valveless graft, and an intraaortic balloon (with a stroke volume of 40 ml) was placed in the descending aorta for the purpose of counterpulsation assisting. Acute severe heart failure model was established by snaring coronary artery branches. The hemodynamic changes of both devices were recorded during, before and after the counterpulsation assisting. Results Eight heart failure sheep models were successfully set up. Cardiac output (CO), pulmonary capillary wedge pressure (PCWP), mean arterial pressure (MAP) and left ventricular end diastolic presssure (LVEDP) after the heart failure were significantly different compared with basic value (t=-8.466, 34.083, 25.767, -5.219, P=0.000). After IABP and PACD assisting, the mean aortic diastolic pressure (MADP) didn’t significantly or did increase (38.34±7.13 mm Hg vs. 38.42±6.81 mm Hg, P=0.418; 38.34±7.13 mm Hg vs.54.14±10.13 mm Hg, P=0.001), and the degree of increasing between the two methods showed a significant difference (P=0.010); LVEDP didn’t significantly decrease (7.43±2.54 mmHg vs. 7.32±2.14 mm Hg, P=0.498; 7.43±2.54 mm Hg vs. 6.53±1.91 mm Hg, P=0.821), and there was no significant difference between the two methods in the change (P=0.651); the coronary sinus flow (CSF) didn’t significantly or did increase (86.63±7.71 ml/min vs. 87.04±6.53 ml/min, P=0.981; 86.63±7.71 ml/min vs. 110.52±11.03 ml/min, P=0.000), and there was a significant difference in the change of CSF between the two methods (P=0.000). IABP didn’t significantly decrease the left carotid artery flow (LCAF) (131.07±21.26 ml/min vs. 128.36±20.38 ml/min, P=0.689), while PACD increased it (131.07±21.26 ml/min vs. 151.29±18.37 ml/min, P=0.008), and there was a significant difference in the change of pressure waveform between the two methods (P=0.002). The thrombus, thrombosis and ischemic necrosis were not found in the hematosac of PACD, artificial blood vessels, heart, lung, liver or kidney of the animal. No apparent abnormalities of the pathohistological sections were detected under optical microscope. Conclusion IABP has no assisting function for the heart of animal with severe heart failure. However, PACD can improve hemodynamic parameters like MADP, returned blood volume in the coronary artery and perfusion volume into the brain, which may become a promising implantable device for severe heart failure.

    Release date:2016-08-30 05:56 Export PDF Favorites Scan
  • 主动脉内球囊反搏在冠状动脉旁路移植术中的应用

    目的 为提高冠状动脉旁路移植术(CABG)的手术疗效, 总结CABG围手术期主动脉内球囊反搏(IABP)应用的临床经验. 方法 回顾性分析46例CABG围手术期行IABP患者的临床资料及IABP放置的原因、时间和预后. 结果 34例康复出院,住院死亡12例,主要死亡原因:低心排血量综合征、肺部感染、多器官功能衰竭等.平均IABP辅助时间28.6±18.2小时.IABP能使平均动脉压升高,心排血量增加,有助于心脏功能差的患者脱离体外循环和改善心脏不停跳冠状动脉旁路移植术(OPCAB)中心脏对稳定器压迫的耐受性. 结论 IABP是一种简单有效的循环辅助手段,心功能差的高危CABG患者应及时放置IABP.放置IABP前应查明下肢血管情况,避免血管损伤.

    Release date:2016-08-30 06:30 Export PDF Favorites Scan
  • IABP辅助下非体外循环冠状动脉旁路移植术治疗冠心病合并严重左心室功能不全

    目的 总结严重左心室功能低下的冠心病患者行主动脉内球囊反搏(IABP)辅助下非体外循环冠状动脉旁路移植术(offpump CABG)的临床经验,以提高手术的成功率。 方法 66例严重左心室功能低下的冠心病患者,男48例,女18例;年龄68.4±10.3岁;左心室射血分数(LVEF)29.6%±5.3%。所有患者均在选择性IABP辅助下行offpump CABG。根据IABP置入的时间不同,将66例患者分为两组,术前IABP置入组:34例,于术前麻醉诱导后置入IABP;术后IABP置入组:32例,在手术完成后置入IABP。回顾分析其临床资料、手术资料、手术结果。结果  66例患者中每例移植血管3.4±0.7支,采用乳内动脉(IMA)66例,且全部吻合于左前降支,采用大隐静脉(SV)64例,桡动脉(RA)5例,吻合于除左前降支以外的所有冠状动脉。于术后15~48 h均顺利停用IABP;围术期死亡1例,于术后29 d发生低心排血量综合征合并肾功能衰竭,死于多器官功能衰竭。所有患者应用IABP后血流动力学和血气指标明显改善,连续心排血量(CCO)、心脏指数(CI)、混合静脉血氧饱和度(SvO2)、有创动脉收缩压(SABP)、有创平均动脉压(MABP)较术前明显升高,而毛细血管楔压(PCWP)较术前明显降低(Plt;0.05)。术前置入IABP组术后住ICU时间、室性心律失常和低心排血量发生率短于或低于术后置入组(Plt;0.05)。随访60例,随访时间1个月~3年,失访5 例。随访期间无心绞痛复发,无心肌梗死发生,心功能分级(NYHA)Ⅰ~Ⅱ级51例,Ⅲ级9例。无晚期死亡。 结论 合理使用IABP,使严重左心室功能低下的冠心病患者施行off-pump CABG有良好的近期效果,该方法是可行的。

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • Intra-aortic Balloon Pump Application Timing after Coronary Artery Bypass Grafting

    ObjectiveTo summarize the experience of intra-aortic balloon pump (IABP) application on coronary artery bypass grafting(CABG)during perioperative period. MethodsWe retrospectively analyzed the data of 82 patients undergoing simple CABG operation in Wuhan Asia Heart Hospital between January 2011 and December 2013. There were 50 male and 32 female patients at age of 49-75 (63.6±11.5) years. The patients were divided into three groups including a group A (12 patients, preoperative-placed IABP), a group B(39 patients , postoperative active placed IABP), and a group C (31 patients, postoperative passive placed IABP). The clinical effects of the three groups were compared. ResultsThere were significantly statistic differences in sequential organ failure assessment (SOFA) score after postoperative 48 hours, ventilator supporting time, IABP supporting time, catecholamine drug usage time, infection incidence, incidence of ventricular arrhythmia, ICU retention time, postoperative hospital stay, CBP usage rate, and postoperative mortality (P<0.05) among the three groups with worse effect in the group C. ConclusionTaking IABP support during CABG perioperative period is an effective treatment. Preventively preoperative and actively postoperative placing IABP can improve the treatment effects significantly. Therefore, patients should apply CABG as soon as possible without hesitation when IABP indications occur.

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  • Effect of preoperative intra-aortic balloon pump insertion in patients undergoing off-pump coronary artery bypass grafting: A retrospective cohort study

    ObjectiveTo evaluate the clinical efficacy of preoperative intra-aortic balloon pump (IABP) insertion in patients with off-pump coronary artery bypass grafting (OPCABG) surgery.MethodsThe clinical data of 130 patients who underwent OPCABG with IABP from 2015 to 2019 in our hospital were retrospectively analyzed. The patients were divided into two groups, including a group A (preoperative IABP insertion, n=72) and a group B (emergent IABP insertion, n=58). There were 42 males and 30 females in the group A with an average age of 60-72 (65.0±5.2) years. There were 32 males and 26 females in the group B with an average age of 56-73 (62.3±7.6) years. The in-hospital mortality rate and prognosis were compared between the two groups.ResultsThe in-hospital mortality rate in the group A (4.2%) was significantly lower than that in the group B (12.1%, P=0.002). The IABP time (40.8±10.3 min vs. 65.3±15.6 min), mechanical ventilation time (18.7±6.1 min vs. 48.7±10.5 min) and ICU stay time (48.1±7.8 min vs. 90.2±21.3 min) of the group A were shorter than those of the group B (P<0.05). The number of bypass grafts was not significantly different between the two groups (3.6±1.2 vs. 3.8±1.0, P=0.387). Multivariable logistic regression analysis indicated that independent risk factors for in-hospital mortality included age [OR=1.04, 95%CI (1.01, 1.10), P=0.030], female [OR=2.56, 95%CI (1.53, 6.12), P=0.000] and left ventricular end-diastolic diameter [OR=1.05, 95%CI (1.01, 1.13), P=0.030]. Preoperative IABP support was the protective factor [OR=0.17, 95%CI (0.01, 0.78), P=0.005].ConclusionPatients undergoing OPCABG with preoperative IABP insertion may reduce in-hospital mortality rate and improve outcomes.

    Release date:2021-10-28 04:13 Export PDF Favorites Scan
  • Relationship between myocardial viability and early application of intra-aortic balloon pump after coronary artery bypass grafting

    ObjectiveTo explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation.MethodsThis retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG.ResultsIn multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG.ConclusionThe myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.

    Release date:2023-03-01 04:15 Export PDF Favorites Scan
  • 体外膜肺氧合联合主动脉内球囊反搏在心脏术后的应用

    目的探讨体外膜肺氧合联合主动脉内球囊反搏术在心脏术后急性心力衰竭中的应用。方法回顾性分析 2012 年 10 月至 2017 年 10 月我院心外三科因急性心力衰竭接受体外膜肺氧合联合主动脉内球囊反搏治疗 38 例患者的临床资料,探索联合应用在心脏术后中的作用。男 24 例、女 14 例,平均年龄(58±11)岁。结果24 例患者成功撤离机械辅助装置,其中 16 例患者存活出院。死亡组肾功能衰竭的发生率显著高于生存组,差异有统计学意义。在不能脱机组的患者中,混合静脉血氧饱和度未见明显好转。结论体外膜肺氧合联合主动脉内球囊反搏可能具有协同作用,在心脏术后急性心力衰竭的治疗中起到一定的辅助作用。

    Release date:2019-01-03 04:52 Export PDF Favorites Scan
  • 主动脉内球囊反搏在冠状动脉旁路移植术围术期的应用

    目的 探讨主动脉内球囊反搏(IABP)在冠状动脉旁路移植术(CABG)围术期的应用效果。 方法 在CABG围术期,对急性心肌梗死(2例)、术中停体外循环困难(16例)、停体外循环后发生低心排血量(7例)和发生恶性心律失常、心跳骤停行心肺复苏后(3例)患者经皮股动脉穿刺置入IABP进行循环辅助。结果 IABP辅助时间36h~7d(74.16±31.64h),住ICU时间为4~27d。围术期死亡3例,死亡率为10.7%(3/28);其余患者均存活。使用IABP后舒张压从48.7±3.1mmHg升至68.0±8.8mmHg(t=4.504 ,Plt;0.01),平均动脉压从52.0±8.8 mmHg上升至73.0±9.5mmHg(t=6.060,Plt;0.01),多巴胺用量由12.8±2.6mmol/L降至8.5±1.3mmol/L(t=3.490,Plt;0.01)。随访25例,随访时间6个月,25例患者心功能均恢复良好,无1例发生并发症。 结论 在CABG围术期使用IABP可明显改善危重患者的心功能,掌握好IABP的使用指征和时机是救治危重患者成功的关键。

    Release date:2016-08-30 06:15 Export PDF Favorites Scan
  • 急性心肌梗死伴心源性休克患者应用主动脉内球囊反搏治疗的观察及护理

    【摘要】 目的 探讨使用主动脉内球囊反搏治疗过程中护理措施对改善患者预后的影响。 方法 选择我科2008年9月〖CD3/5〗2009年5月使用主动脉内球囊反搏治疗急性心肌梗死伴心源性休克的9例患者,对治疗过程进行了观察及全面合理的护理。 结果 主动脉内球囊反搏治疗患者,取得了满意的效果。 结论 主动脉内球囊反搏患者病情复杂危重,使用过程中需辅以全面合理的护理措施,防止并发症发生,对改善患者预后有益。

    Release date:2016-09-08 09:45 Export PDF Favorites Scan
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