Percutaneous cardiopulmonary support with heparin-coated circuits in postcardiotomy cardiogenic shock. Efficacy and comparison with left heart bypass.
Percutaneous cardiopulmonary support with heparin-coated circuits in postcardiotomy cardiogenic shock. Efficacy and comparison with left heart bypass.
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心脏切开术后心源性休克中使用肝素涂层回路的经皮心肺支持。
DOI：
10.1007/bf03218139
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
H. Matsuda
中科院分区：
文献类型：
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作者：
Y. Hayashi;S. Ohtake;Y. Sawa;M. Nishimura;H. Ichikawa;H. Satoh;T. Yamaguchi;H. Suhara;T. Sakaguchi;H. Matsuda
目的：经皮心肺支持，一种简化的静脉动脉旁路术，使用完全肝素涂层回路，最近已进入临床使用。为了澄清其疗效，在心切开术后心源性休克，以帮助断奶体外循环，我们比较了经皮心肺支持的结果与使用离心pump.Methods的左心转流：我们回顾了18例患者在1991年和1998年之间治疗谁不能断奶体外循环。9例采用肝素涂层经皮心肺支持（PCPS组），9例采用离心泵左心转流（LHB组）。在这两个组中，活化凝血时间控制在150-200秒，使用最小剂量的肝素作为needing.Results：断奶和生存率较高的PCPS组比LHB组（100%比55.6%，和66.7%比22.2%）。PCPS组失血量较少，术后即刻需要的血液成分量较少。1例经皮心肺支持患者因术后出血需要再次手术探查（11.1%），但PCPS组未发生临床血栓栓塞事件。在LHB组中，5例患者进行了手术再探查术后出血（55.6%），2例进行了血栓摘除术在左心室（22.2%）。结论：虽然这项研究是回顾性的，历史背景可能已经参与，我们的数据表明，完全肝素涂层经皮心肺支持系统出现更有效的援助，从体外循环脱机，并在短期循环支持患者心切开术后心源性休克。
Objective:Percutaneous cardiopulmonary support, a simplified form of venoarterial bypass, using totally heparin-coated circuits, has recently come into clinical use. To clarify its efficacy in postcardiotomy cardiogenic shock to aid weaning from cardiopulmonary bypass, we compared results of percutaneous cardiopulmonary support with those of left heart bypass using a centrifugal pump.Methods:We reviewed 18 patients treated between 1991 and 1998 who could not be weaned from cardiopulmonary bypass. Nine were aided by totally heparin-coated percutaneous cardiopulmonary support (PCPS group), and 9 supported by left heart bypass using a centrifugal pump (LHB group). In both groups, activated clotting time was controlled at 150–200 seconds using minimal doses of heparin as needed.Results:Weaning and survival rates were higher in the PCPS group than in the LHB group (100% vs 55.6%, and 66.7% vs 22.2%). The PCPS group had a smaller amount of blood loss and needed a smaller amount of blood components in the immediate postoperative period. One percutaneous cardiopulmonary support patient required surgical re-exploration for postoperative bleeding (11.1%), but no clinical thromboembolic event occurred in the PCPS group. In the LHB group, 5 patients underwent surgical re-exploration for postoperative bleeding (55.6%), and 2 underwent thrombus extirpation in the left ventricle (22.2%).Conclusions:Although this study was retrospective and historical backgrounds could have been involved, our data suggest that totally heparin-coated percutaneous cardiopulmonary support system appears more effective as an aid to weaning from cardiopulmonary bypass and in short-term circulatory support for patients in postcardiotomy cardiogenic shock.