主动脉内球囊反搏术对预防瓣膜置换术后低心排综合征的临床效果研究OA
Clinical effect of intra-aortic balloon counterpulsation in preventing low cardiac output syndrome after valve replacement surgery
目的 探讨主动脉内球囊反搏术(IABP)对预防瓣膜置换术后继发低心排综合征(LCOS)的临床效果.方法 选取2022年2月至2024年6月该院收治的115例心脏瓣膜病患者开展前瞻性随机对照试验,根据患者病情及手术意愿将患者分为常规组57例、IABP组58例.常规组实施常规心脏瓣膜置换术治疗,IABP组采用IABP辅助心脏瓣膜置换术治疗,治疗后随访半年,比较2组患者血流动力学参数、心肌损伤标志物、临床指标及心功能恢复情况.结果 治疗后,IABP组患者平均动脉压、心率、心输出量、心脏指数均高于常规组,心肌肌钙蛋白、肌酸激酶同工酶、乳酸脱氢酶、缺血修饰蛋白均低于常规组,差异均有统计学意义(P<0.05).IABP组患者术中血管活性药物用量、术后辅助呼吸时间、ICU停留时间、住院时间、LCOS发生率均优于常规组,差异均有统计学意义(P<0.05).截至随访结束时,IABP组患者左心室射血分数、左心室舒张早期/舒张末期血流速度均高于常规组,左心室舒张末期容积、左心室收缩末期容积均低于常规组,差异均有统计学意义(P<0.05).结论 IABP辅助瓣膜置换术能改善心脏瓣膜病患者血流动力学,并减轻心肌损伤,对减少术中血管活性药物用量、加快术后恢复进程、降低LCOS发生风险,并促进患者心功能恢复均有积极影响.
Objective To explore the clinical efficacy of intra-aortic balloon counterpulsation(IABP)in preventing secondary low cardiac output syndrome(LCOS)after valve replacement surgery.Methods A total of 115 patients with heart valve disease admitted to our hospital from February 2022 to June 2024 were en-rolled in a prospective randomized controlled trial.According to the patients'conditions and surgical willing-ness,they were divided into the conventional group of 57 cases and the IABP group of 58 cases.The conven-tional group underwent routine heart valve replacement surgery,while the IABP group underwent IABP-assis-ted heart valve replacement surgery.All patients were followed up for six months after treatment.Hemody-namic parameters,myocardial injury markers,clinical indicators,and cardiac function recovery were compared between the two groups.Results After treatment,the mean arterial pressure,heart rate,cardiac output,and cardiac index in the IABP group were significantly higher than those in the conventional group,while cardiac troponin T,creatine kinase isoenzyme,lactate dehydrogenase,and ischemia-modified albumin were significant-ly lower than those in the conventional group,with statistically significant differences(P<0.05).The intrao-perative dosage of vasoactive substances,postoperative assisted ventilation time,ICU stay duration,hospital stay duration,and incidence of LCOS in the IABP group were better than those in the conventional group,with statistically significant differences(P<0.05).At the end of follow-up,the left ventricular ejection fraction and early diastolic/late diastolic flow velocity ratio in the IABP group were higher than those in the conven-tional group,while the left ventricular end-diastolic volume and left ventricular end-systolic volume were low-er than those in the conventional group,with statistically significant differences(P<0.05).Conclusion IABP-as-sisted valve replacement surgery can improve hemodynamics and reduce myocardial damage in patients with heart valve disease.It plays a positive role in reducing the intraoperative dosage of vasoactive substances,ac-celerating postoperative recovery process,decreasing the risk of LCOS,and promoting cardiac function recov-ery in patients.
冯永飞;张丁乾;潘丽红
河南大学第一附属医院心血管外科,河南 开封 475000河南大学第一附属医院心血管外科,河南 开封 475000河南大学第一附属医院心血管外科,河南 开封 475000
医药卫生
瓣膜置换术主动脉内球囊反搏术血流动力学心肌损伤心功能
Valve replacement surgeryIntra-aortic balloon counterpulsationHemodynamicsMyocardial injuryCardiac function
《现代医药卫生》 2026 (3)
535-539,5
河南省医学科技攻关计划项目(LHGJ20200552、SBGJ202302087).
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