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find Keyword "低心排血量综合征" 7 results
  • Pulse Indicated Continuous Cardiac Output for Low Cardiac Output Patients after Coronary Artery Bypass Grafting

    ObjectiveTo analyze the significance of application of pulse indicated continuous cardiac output (PICCO) as hemodynamic monitoring for low cardiac output patients after coronary artery bypass grafting (CABG) operation. Method We retrospectively analyzed the clinical data of 110 patients conducted non-extracorporeal circulation CABG operation in Beijing Anzhen Hospital between June 2013 and October 2014. The patient were divided into two groups including a PICCO applied group and a non-PICCO applied group. There were 49 patients including 29 males and 20 females at average age of 60.80±9.34 years in the PICCO group. There were 61 patients with 37 males and 24 females at age of 62.22±10.41 years in the non-PICCO group. We compared the treatment effects between the two groups. ResultsComparing to the non-PICCO group, the PICCO group had shorter average days of postoperative intra-aortic balloon pump (IABP) usage (t=2.155, P=0.039), less usage rate of endotracheal reintubation (χ2=5.098, P=0.039), shorter average postoperative mechanical ventilation time (t=2.087, P=0.044), less occurrence rate of cardiac arrhythmia (χ2=4.011, P=0.045), less occurrence rate of multiple organ dysfunction syndrome (MODS) (χ2=5.075, P=0.035), shorter days in ICU (t=2.141, P=0.040) and in-hospital time (t=2.061 P=0.048). During monitoring, the PICCO group had slower average heart rate, higher average arterial pressure, lower blood lactate, greater oxygenation and greater left ventricular ejection fraction (LVEF) than those in the non-PICCO group. ConclusionThe application of PICCO reduces occurrence of postoperative complications for low cardiac output patients with post coronary artery bypass grafting operation, increases cure rate.

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  • 心瓣膜置换术后早期心肌顿抑致低心排血量综合征的诊治经验

    目的 探讨心瓣膜置换术后早期心肌顿抑的识别、诊断,以及由此导致严重低心排血量综合征(LCOS)的治疗方法,以提高诊断、治疗水平。 方法 回顾分析我科2004年9月至2006年9月期间4例心瓣膜置换术后早期出现心肌顿抑导致LCOS患者的临床资料,4例均为女性,年龄35~54岁,平均年龄46-75岁。术前左心室大小、收缩功能均基本正常,左心室舒张期末内径(LVEDD)3.5~6.3 cm,射血分数(EF)49%~61%;2例行二尖瓣、主动脉瓣置换术,1例行二尖瓣置换术,1例行主动脉瓣置换术。 结果 4例患者均在术后早期(14~40 h、平均26 h)出现无明确原因的LCOS,给予大剂量肾上腺素[0.10~0.15 μg/(min·kg)]治疗无效而改行主动脉内球囊反搏(IABP)治疗,4例患者IABP支持时间为7~12 d(平均8.5 d),3例痊愈,1例因肺部感染于术后28 d死于多器官功能衰竭。2例出现急性肾功能不全,1例7 d后肾功能恢复正常,1例经腹膜透析治疗2周后痊愈。 结论 心肌顿抑可出现在术前心功能良好,手术经过顺利的心瓣膜置换术患者,由心肌顿抑导致的术后早期LCOS,及时应用IABP可以减轻心脏负荷,增加冠状动脉灌注,改善重要脏器循环,有助于左心室渡过心肌顿抑期,恢复收缩功能,是成功救治的重要手段。

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 左心转流在心脏直视术后的应用

    目的总结左心转流抢救心脏直视术后重度低心排血量的经验. 方法 5例心瓣膜置换术患者术后发生顽固性低心排血量,应用Delphin Ⅱ型离心泵,经左心房-离心泵-主动脉或股动脉建立左心转流辅助循环. 结果 5例均顺利脱离左心辅助,1例因心律失常早期死亡,2例晚期分别死于右心功能不全、多器官功能衰竭,2例痊愈出院.结论重度低心排血量患者及时果断应用左心辅助,疗效确切,防止左心转流并发症,改善术后右心功能是提高左心转流成功率的关键.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • Surgical Treatment of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

    ObjectiveTo explore surgical methods and risk factors of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). MethodsClinical data of 28 ALCAPA patients who underwent surgical repair from October 1993 to September 2013 in Beijing Anzhen Hospital were retrospectively reviewed. There were 8 male and 20 female patients with their age of 0.6-l6.8 (4.3±0.7)years including 10 patients less than 1 years old. Surgical procedures included simple ligation of left coronary artery, intrapulmonary tunnel procedure (Takeuchi)and direct coronary reimplantation of the anomalous artery. Postoperative death, complication and cardiac function were observed. ResultsAmong the 28 patients, 1 patient received simple ligation of left coronary artery, and 7 patients received intrapulmonary tunnel procedure (Takeuchi), among whom 2 patients died postoperatively. Twenty patients received direct implantation of the anomalous artery into the ascending aorta, and 3 patients died postoperatively. Five patients who died postoperatively were 10.20±3.27 months old, including 3 patients with moderate mitral regurgitation (MR)and 2 patients with mild MR preoperatively. Preoperative heart function of the patients who died postoperatively was significantly reduced. Preoperative left ventricular ejection fraction of the patients who died postoperatively was significantly lower than that of the patients who survived (36.6%±8.5% vs. 60.9%±10.7%, P=0.000). Low cardiac output syndrome was the reason for all postoperative death. All survival patients were followed up from 1 month to 18 years. One patient who underwent intra-pulmonary tunnel procedure (Takeuchi)received pulmonary artery balloon dilatation for pulmonary supravalvular stenosis 15 years after discharge. None of the other patients received a secondary operation. During follow-up, left ventricular function was improved. Growth and development of all the patients was normal. MR did not significantly aggravate in all the patients. ConclusionPatients with younger age and worse left ventricular function have greater surgical risks of ALCAPA.

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  • Progressive volume deflation followed by rate reduction in weaning intra-aortic balloon pump

    Objective To investigate the changes of hemodynamics in patients weaning intra-aortic balloon pump (IABP) by using progressive volume deflation followed by rate reduction. Methods We retrospectively analyzed the clinical data of 36 patients aged 68.9±4.7 years, 22 males and 14 females, who underwent progressive volume deflation followed by rate reduction for IABP weaning in Xinhua Hospital between September 2006 and January 2016. Progressive volume deflation followed by rate reduction was used to wean IABP and collect hemodynamics parameters of each time point. Results All the patients successfully weaned IABP. One patient got re-IABP assistant 36 hours after the first successful weaning. One early death and three patients (8%) with postoperative IABP-related complications were embolization of the toe artery. One was in ipsilateral limb, and two of contralateral limb. One patient with acute hepatic insufficiency and one patient with acute renal insufficiency cured after treatment. Conclusion Intra-aortic balloon pump weaning is successful by using volume deflation followed by rate reduction which allowed better hemodynamic parameters.

    Release date:2018-03-05 03:32 Export PDF Favorites Scan
  • 心脏直视手术后早期心肌顿抑的诊断与治疗

    目的探讨心脏瓣膜置换术后早期心肌顿抑的诊断及治疗以及其所引起的低心排血量综合征(LCOS)的诊疗。 方法回顾性分析我院 2011 年 1 月至 2018 年 3 月期间 42 例心脏瓣膜置换术后早期出现心肌顿抑导致 LCOS 患者的临床资料,其中男 19 例、女 23 例,年龄 38~55(47.91±5.51)岁。术前左心室舒张末期内径(LVEDD)3.8~6.5(5.3±0.9)cm,左心室射血分数(EF)45%~60%(51.2%±5.3%);冠状动脉粥样硬化性心脏病筛查均为阴性;其中单纯主动脉瓣置换 12 例,二尖瓣置换合并三尖瓣成形 15 例,二尖瓣和主动脉瓣置换 15 例。 结果42 例患者均在术后早期[10~24(18.83±4.24)h]出现无明确原因的 LCOS,大剂量肾上腺素[0.06~0.10 μg/(kg·min)]和去甲肾上腺素[0.1~0.5 μg/(kg·min)]治疗无效而加用主动脉内球囊反搏(IABP)治疗,其中 25 例患者行肾脏替代治疗(CRRT)。IABP 辅助时间 3~10(5.16±1.95)d,CRRT 治疗时间 22~61(42.17±10.75)h。40 例患者痊愈出院,2 例患者院内死亡,1 例死于脓毒血症,1 例患者死于恶性心律失常。 结论心脏瓣膜置换术后早期出现心肌顿抑引起病情突变恶化,如能早期诊断、早期治疗,将取得好的临床结果。IABP 可以减轻心脏负荷,增加冠状动脉灌注,改善循环,有助于患者渡过心肌顿抑期;CRRT 可以改善 LCOS 患者内环境,减轻肾脏负担。两者是成功救治此类患者的重要手段。

    Release date:2019-03-01 05:23 Export PDF Favorites Scan
  • Clinical analysis of extracorporeal membrane oxygenation for 26 adult patients after cardiac surgical procedures

    ObjectiveTo summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac surgery, analyze the risk factors associated with the mortality and other severe complications and to discuss prevention methods of complications during ECMO treatment.MethodsThe clinical data of 26 patients with cardiac surgery, who underwent ECMO because of cardiopulmonary insufficiency ect in Zhongshan Hospital, Fudan University from January 2012 to September 2017, were retrospectively analyzed. There were 19 males and 7 females aged 24–80 (58.0±13.9) years.ResultsTwelve (42.3%) patients successfully weaned from ECMO and six (23.1%) were discharged from hospital. Among 26 patients, 24 received VA ECMO (veno-arterial ECMO), including 5 after heart transplantation, 9 after heart valve surgery, and 3 were successfully weaned from ECMO. Seven patients with valvular surgery underwent ECMO within 48 hours due to refractory low cardiac output syndrome (LCOS). Eight patients underwent major angioplasty, 3 of whom were successfully weaned from ECMO. Four patients underwent coronary artery bypass grafting and other cardiac surgeries. Patients with VA ECMO were treated with femoral vein-femoral artery cannulation except for 2 patients undergoing femoral vein-radial artery cannulation after major angioplasty. Patients with VV ECMO (veno-venous ECMO) underwent femoral vein-jugular vein cannulation. After ECMO support, 10 patients with bleeding occurred, and 5 patients were successfully weaned from ECMO. All patients had transfusion therapy during the assist period, 7 patients had infection after ECMO support, 4 patients suffered severe distal limb ischemia. There was no significant difference in the lactic acid between the survival and the dead patients before and after ECMO support. However, the decline of serum lactic acid in the survivors was faster than that of the dead patients. The trend was the most significant within 6 h after the operation.ConclusionECMO is one of the significant treatments for LCOS and refractory hypoxemia after cardiac surgery. The type of cardiac surgery and the timing of catheter placement are key factors for the success of ECMO. The different ways of ECMO intubation, prevention and control of bleeding during ECMO, monitoring and management of internal environment and the strategies of anti-infection are all important for success of ECMO.

    Release date:2019-06-18 10:20 Export PDF Favorites Scan
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