【摘要】 目的　探讨心脏手术辅助循环期间并发症的防治方法。方法　 13例患者因心脏手术后低心排不能脱离心肺转流 (CPB)或术后严重室性心律失常和心脏骤停 ,分别采用主动脉内球囊反搏、转子泵或离子泵左心室辅助和体外膜肺氧合等辅助循环方法治疗。结果　 6例 (4 6 .2 % )存活出院 ,平均辅助循环时间 43h ;辅助循环期间平均输库血 6 80 0ml、血浆 480 0ml。并发症 :10例 (76 .9% )合并胸腔、心包或纵膈引流多 ,采用红细胞清洗和重输入装置 (CellSaver)治疗 ;4例 (30 .8% )并发急性肾功能衰竭 (ARF)行床旁血液透析 ,1例治愈。结论　出血是辅助循环早期最常见的并发症 ,采用CellSaver能够减少库血输入量 ;ARF是导致患者死亡的常见原因 ,并发ARF的患者宜尽早行床旁血液透析治疗。更多还原

【Abstract】 Objective To explore the therapeutic management of complications in assisted circulation (AC) following cardiac operation. Methods Of the 13 patients in the series, 12 were male and 1 female. The age ranged from 44 to 72 years (mean, 61 years). The techniques of circulatory assistance were attempted including cooler or centrifugal pump left ventricular assist, intraaortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO). 9 patients required AC to be weaned off from cardiopulmonary bypass (DPB), in the other 4 patients AC were instituted in the ICU postoperatively because of progressive heart failure, cardiac arrest, or ventricular arrhythmia. Results 6 of the 13 (46.2%) patients were discharged. The length of duration of assisted criculation ranged from 6～136 hours with a mean of 43 hours. Overall 76.9 percent of patients bled from the chest tubes, skin wound and mucosal ulceration. Four patients (30.8%) developed acute renal failure (ARF) requiring continuous venovenous hemodiafiltriation (CVVHDF) and only one was alive. The cause of death in the 7 patients (53.8%) was progressive deterioration of cardiac function associated with multiorgan failure in all instances. Conclusion Bleeding is the most common complication in assisted circulation. Cell Savers can be used to reduce the quantity of blood transfusion. CVVHDF is the dialytic option of choice in cardiac surgery patients with severe ARF.更多还原