长时间滚压泵辅助循环管理体会

摘要

目的 总结本院51例心脏术后心脏和/或肺功能不全滚压泵长时间辅助循环(VAD)管理经验.方法 51例心脏术后患者因心脏和/或肺功能不全而难以脱离体外循环,采用滚压泵进行长时间心肺功能辅助,根据患者心肺功能状态分别采用全心辅助和单纯左心辅助两种辅助方式,辅助期间尽可能提供满意的灌注流量,重视各种脏器保护,注意维持内环境稳定,妥善调节前后负荷之间的关系.结果 全心辅助43例(其中单纯呼吸功能不全13例,全心功能不全27例,呼吸功能不全合并左心功能不全3例),单纯左心辅助8例.VAD时间360～1020(679±29)min,辅助后脱机或在IABP辅助下脱机并存活至出ICU 23例,辅助后不能脱机17例,辅助后脱机或在IABP辅助下脱机但术后10 d内死于ICU 11例.结论 心脏术后因心肺功能不全而难以脱离体外循环时应积极对衰竭器官进行辅助.选择适当辅助方式,精心进行流量调控,妥善进行前、后负荷管理,维持稳定内环境状态,可提高辅助成功率.%OBJECTIVE To summarize the management experience of long duration roller pump ventricular assist device ( VAD ) for left heart assistance in 51 post cardiac surgery patients with heart and/or lung dysfunction. METHODS Ventricular assist devices of roller pump were used for 51 patients who couldn't wean off ECC because of heart and/or lung dysfunction. According to patients' heart and lung condition, biventricular assist advice and left ventricular assist device were used respectively. During assistance,satisfactoryperfusion blood flow was provided and much attention was paid to the conservation of major organs. Body internal environment was maintained in normal status. The relationship between preload and afterload of the heart was adjusted adequately. RESULTS Biventricular assist device was used in 43 cases ( pure respiratory insufficiency 13 cases, biventricular dysfuntion 27 cases, respiratory insufficiency and left heart insufficiency 3 cases ) and left ventricular assist device was used in 8 cases. Total time of assistance was 360 - 1020 ( 679 ± 29 ) minutes. 23 patients weaned off assistance successfully or weaned off assistance with IABP and survive to discharge. 17 patients couldn't wean off assistance. 11 patients who weaned off assistance with or without IABP died in ICU within 10 days. CONCLUSION Roller pump VAD should be used when postoperative heart and/or lung dysfunction occurred. Choosing suitable types of assistance, controlling assistance blood flow elaborately, maintaining proper modifications of preload and afterload of the heart and maintaining stable body internal environment can improve the effect of the ventricular assistance.