主动脉内球囊反搏应用于冠状动脉旁路移植术的监护(Applicationofintraaorticballoonpumpincoronary

1、主动脉内球囊反搏应用于冠状动脉旁路移植术的监护(Applicati on of intra aortic ballo on pump incoronary artery bypass graft ing )主动脉内球囊反搏应用于冠状动脉旁路移植术的监护(Application of intra aortic balloon pump in coronary arterybypass grafti ng )主动脉内球囊反搏应用于冠状动脉旁路移植术的 监护(Application of intra aortic balloon pump in coronaryartery bypass graft

2、ing ) Application of intra aortic balloon pump in coronary artery bypass graft ing 2019-07-21 Li Yan hua, Yang Xiaohui, Yang Manqing Abstract: Objective To investigate the sig nifica neeof intra aorticballo onpump (IABP) incor onary artery bypass grafting (CABG). Methods 60 cases of CABG patie nts t

3、hrough femoral artery pun cture or in dwelli ngIABP catheter in the aorta, assisted circulation, monitoringECG, arterial pressure cha nges and hemod yn amic parameters of the waveform, the effect ide ntificati on of IABP, among which2 cases were placed before CABG. Results 45 cases (75%) were cured

4、and 6 cases had complications.Conclusion as long as theindications and the timing of IABP are correctly mastered, IABP can be used to rescue critically ill patients in CABG,and good clinical results can be obtained. During the implementation ofIABP, close monitoring should be taken to prevent compli

5、cations such as lower extremity thrombosis, bleeding, edema, infection and rupture of the air sac, and psychological nursing should be done. Key words intra aortic balloon pumpbypass grafting mon itori ng IABP is beco ming more and more widely used as a treatment for postoperative low cardiac output

6、 syndrome (LCOS) and pump failure. The method is through the femoral artery puncture indwelling IABP catheter in the descending aorta ballo on tip in the left subclavia n artery is in flated duri ng diastole, in crease in tra aortic diastolic pressure, the cor onaryartery and distal blood perfusi on

7、,in creasemyocardial blood supply; systolic an terior (isovolumic) air exhaust, aortic pressure drop, cardiac the blood resista nee decreased, myocardial wall tension and myocardialoxygenconsumption decreased 1, reduced cardiac work, so as to achieve the effect of improving heart function. This arti

8、cle discusses the monitoringof CABGcritically ill patients during theresuscitationperiod during the 60 IABP treatment from May1995to December 1999 in ICU. cli nical data 60 cases of IABP patie nts: male 54 cases, female 6 cases, age 48 to 75 years of age, preoperative myocardial ischemia or acute my

9、ocardial infarctionin 25 cases, preoperative left ventricularejectionfracti on (EF) from 34%to 83%, the nu mber is 1 5 bypass, aortic clamping time was 100 253 min, extracorporeal circulation time from 171 to 610 min, the IABP time is 14 210 h, the femoral artery incisionor direct puncture establish

10、ingIABP, type 90,type 97 coun terpulsati on in strume nt. 2 of them were placed in front of CABG. Complicati ons in cluded pul monary in fecti on in3 cases, distalfemoral thrombosis in 1 cases, deep veinthrombosis in 1 cases, and left peroneal external nerve injury in 1 cases, all were cured. Result

11、s:45 cases (75%) weresuccessful, 15 cases died. The causes of death were severe LCOS in 10 cases, renal failure in 3 cases, acute gastr oin testi nal hemorrhage in 1 cases, and cerebral hemorrhage in 1 cases.Custody 1.: IABPmon itori ng ECG using ECGtriggered, a. Theoptional R wave tip, T wave flat

12、lead, in order to trigger coun terpulsati on. Close observati on of cha nges in patie nts with recurrent arrhythmia,conventional ICU after recording 12lead ECG, un dersta nd the myocardial blood supply; regularly review blood gas, electrolyte, correct electrolyte acid-base imbala nee; pay atte ntio

13、n to whether the abno rmal Q wave, ST segment, low heart rate, so that the processing and. 2. monitoringblood pressure: To observe changes in arterial pressure waveforms and to record the measured pressure data.The aortic diastolic pressure after maintenance was about 1015 mmHJpwer than that in the

14、non adjuvant group, and the systolic pressure was about 510 mmHJpwer than that in the non adjuvant group. Coun terpulasti on treatme nt, arterial wave heavy no tch and end diastolic waveform shows the shape of V. Keepthepressure gauge clear, can be con sta nt speed pump with 1/1 000 hepari n sali ne

15、, 2 mL per hour push injecti on. If the arterial waveform disappears, consider that the catheter is inserted too deep or the pressure vessel has a clot obstructi on. If the catheter and the safe room are filled with blood, the airbag is ruptured and immediately inspected. This case was not found in

16、this group. 3. left atrial pressure (LAP) / pulmonary hair pressure (PCWP)and central venous pressure (CVP) monitoring: normal LAP at 615 mmHg/PCWP at 812 mmHg, CVP at 612 cm H2O. The way to keep the pressure gauge smooth is the sameas above. WhenLAP/PCWi% low and CVPs low, it indicates that the vol

17、ume of blood is in sufficie nt and the cardiac output drops; whe nLAP/PCWP is high, CPV normal or low,suggest ing that thereduction incardiac output, left ventricular dysfunctionandpul monary con gestio n; the abno rmal in crease of CABG patie nts with CVP, ofte n prompts acute cardiac tamp on ade a

18、nd pul monaryvascular resista nee in creased (such as pul monary edema, atelectasis, etc.). Therefore, the dynamic observation of LAP/PCWP/CVP can help to guide the volume of tra nsfusion to regulate blood volume, maintain cardiac output 2, and monitor the recovery of cardiac function after operatio

19、n. Observation and nursing of 4. peripheral circulatio n:check bodytemperature, color and pulsati on of dorsal artery of foot;avoid local incision intubation limb compression, prevention of distal ischemia; observe the removal of the venous side of the lower limb blood supply, every 4 h for a massag

20、e, and raise the limb15 degrees for venous return of; peripheralcirculation bad patients pay attention to body warm, high fever cooling. 5. take X-ray every day to understand the location of the air sac and the lung. The position of the air bag is too low compression of the renal artery, renal insuf

21、ficiency 3, have little or no urine; while IABP patients often assistedbreathing, IABP catheterinsertionlimits the patient sactivities,incidenee of infection,pulmonary atelectasis etc.Therefore, we must pay attentionto lung, kidney and other majororgan functionmonitoring.6. preventionof thrombosis:h

22、eparin should be anticoagulant during IABP. The dose was 0.5mg/kg, 1 times for 68 h, or 1 000U for subcutaneous injection, 750010 times a day, and the activated clotting time (ACT) was adjusted to adjust the dosage of heparin, and the ACTvalue was 170200 s. Should pay atte ntio nto observe the woun

23、d, lead flow,gastric juice, whether bleed ing tenden cy. 7., preve nti on of in fecti on: pay atte ntio n to observe the pun cture site with or without ooz ing of blood and hematoma, every day un der aseptic operationchange dressing,understandthe wound localsituation,routine use of antibiotics. 8. s

24、table diseaseevacuati on IABP, percuta neous pun cture with ballo on catheter after local compressi on to 30 min, and 6 8 elastic ban dages wrapped h; drain age will be artificial vascular stump with 5/0 Proleve suture, to cover the wound with a steriledressing. Atthe sametime, we should observe the

25、 pulse of the dorsal artery of the ipsilateral side of the patient. If the pulse disappears or weake ns, it should be con sidered whether the embolism may be dealt with in time. In this group, 1 patie nts with distal thrombosisun derwe nt thrombectomy with Forgirty ballo oncatheter when they were ev

26、acuated from IABP. 9. pay attention to psychological nursing: CABCpatie nts,age gen erally larger,preoperative psychological burde n, postoperative recovery, more because of the cha nge of the surro unding en vir onment andlimited physical activity and fear, suspicion, irritability, weshould take th

27、e initiative to care for the patient, introduce a newenvironment and give the explanation,properly raise thebed (should be less tha n 30 degrees). I n order to avoid the ballo on catheter in serted into the aorta deep dan ger; to keep the en vir onment clea n and quiet, to have the con fide nee to a

28、ccept and cooperate with the treatme nt of patie nts. Proper adm ini strati on of the tow n s static pain age nt is con duciveto a smooth recovery of cardiopulm onaryresuscitati on.discuss Whether CABG patie nts un derg oing IABP treatme nt had no significantdiffereneein gender,age, preoperativemyoc

29、ardial ischemia or myocardial in farctio n history and bypass surgery in number, and the value of preoperative EF and in traoperative aortic clamp ing time, postoperative n eed to support the possibility of IABP 4. In this group, 60 patients with CABG prese nted with acute myocardial in farcti on, LCOS, cardiogenic shock and severe ventricular arrhythmia during the perioperative period. IABP assisted circulati onwas performedimmediately and good clinicalresults were achieved. Of the 60patients with IABP, 45 were successfully treate