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心血管术后心原性休克患者同时启动IABP效果更好

2019-05-31 朱朱 中国循环杂志

阜外医院心外科胡盛寿院士研究团队报告,在心血管术后心原性休克患者的救治中,体外膜肺氧合(ECMO)同时联合主动脉内球囊(IABP)辅助可带来更好的生存获益,还可减少由于外周灌注不足引起的肾脑并发症。

阜外医院心外科胡盛寿院士研究团队报告,在血管术后心原性休克患者的救治中,体外膜肺氧合(ECMO)同时联合主动脉内球囊(IABP)辅助可带来更好的生存获益,还可减少由于外周灌注不足引起的肾脑并发症。

研究者回顾性分析阜外医院2005年1月1日至2017年12月31日152例因心原性休克接受ECMO辅助循环的成人患者临床资料,其中生存出院(成功脱机并存活出院)患者73例,其余79例撤机后院内死亡或未成功脱机(非生存出院)。

结果显示,49例(32.2%)患者在ECMO的同时,启动了IABP辅助,28例(18.4%)患者在安装ECMO前、后启动IABP辅助。

ECMO的总体脱机率为56.6%,院内死亡率为52.0%(79/152)。

生存出院患者与非生存出院患者相比,术前合并高血压比例、体外膜肺氧合安装前二次开胸比例、ECMO安装前心跳骤停或心室颤动发生率、ECMO安装比例均较低,而心脏移植手术和同时启动主动脉内球囊反搏比例均较高。

多因素Logistic 回归分析显示,同时启动ECMO和主动脉内球囊反搏是血管术后心原性休克患者生存出院的唯一独立保护因素(OR=0.375)。

另外,同时启动体外膜肺氧合和主动脉内球囊反搏者与单用ECMO者相比,需要持续血滤治疗的比例(30.6% vs 49.3%)和神经系统并发症发生率(8.2% vs 22.7%)均较低,但血栓形成发生率增高(18.4% vs 2.7%)。

研究者建议,如无禁忌证,心血管术后心原性休克患者应积极使用ECMO与主动脉内球囊反搏同时启动的辅助方案,同时积极预防血栓并发症。

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    2019-06-24 wleon8895
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1740237, encodeId=40bb1e40237d9, content=<a href='/topic/show?id=77905092464' target=_blank style='color:#2F92EE;'>#心原性休克#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50924, encryptionId=77905092464, topicName=心原性休克)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6e6534685152, createdName=12498bd5m27暂无昵称, createdTime=Wed Dec 25 02:56:00 CST 2019, time=2019-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2049831, encodeId=b9902049831fe, content=<a href='/topic/show?id=4a5f1e68a9' target=_blank style='color:#2F92EE;'>#ABP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1768, encryptionId=4a5f1e68a9, topicName=ABP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Mon Jun 24 13:56:00 CST 2019, time=2019-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615309, encodeId=c611161530995, content=<a href='/topic/show?id=1e2c92e53e' target=_blank style='color:#2F92EE;'>#IABP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9275, encryptionId=1e2c92e53e, topicName=IABP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cba419597616, createdName=ms4964546379600229, createdTime=Sun Jun 02 09:56:00 CST 2019, time=2019-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1046830, encodeId=cb2c104683008, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Fri May 31 21:56:00 CST 2019, time=2019-05-31, status=1, ipAttribution=)]
    2019-05-31 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

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