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find Keyword "心源性休克" 7 results
  • 急性心肌梗死合并心源性休克手术治疗六例

    摘要: 目的 总结急诊冠状动脉旁路移植术(CABG)救治急性心肌梗死(AMI)合并心源性休克(CS)患者的早期临床结果和经验,以评估手术疗效。 方法 自2006年10月至2008年10月中国海洋大学附属青岛市市立医院共对6例急性心肌梗死合并心源性休克患者施行急诊CABG,其中男4例,女2例;年龄62~78岁(68.3±7.9岁);从发生休克距开始手术时间为1~7 h(4.1±3.1 h);冠状动脉狭窄90%以上病变支数1~3支(2.5±1.3支)。1例采用非体外循环(offpump CABG)技术,5例采用体外循环心脏停跳(onpump CABG)技术,心肌保护采用顺行性灌注结合经冠状静脉窦逆行灌注心肌保护方式。 结果 每例患者平均移植血管3支(1~4支),安装主动脉内球囊反搏(IABP)3例。 1例患者术后第3 d死于循环衰竭合并肾功能衰竭,病死率16.67%(1/6), 5例治愈出院。围手术期发生呼吸功能不全2例,急性肾功能不全1例。出院3个月后随访,心功能分级(NYHA)Ⅲ级3例,Ⅱ级2例;1年后随访心功能Ⅲ级1例,Ⅱ级2例,Ⅰ级2例。 结论 急诊CABG可以有效提高急性心肌梗死合并心源性休克患者的生存率。

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  • The Optimal Timing and Operation Pattern of Emergent Coronary Artery Bypass Grafting after Acute Myocardial Infarction

    Objective To summarize the efficacy and clinical experiences of emergent coronary artery bypass grafting (E-CABG) in patients with acute myocardial infarction (AMI) and to discuss the operative opportunity and procedures. Methods We retrospectively analyzed the clinical data of 21 patients with AMI undergoing E-CABG in Sun Yatsen Cardiovascular Disease Hospital between June 1999 and December 2009. Among the patients, there were 14 males and 7 females with their age ranged from 24 to 81 years (63.9±12.4 years). Six patients were operated within 6 hours after the onset of AMI, 7 patients were operated from 6 hours to 3 days after the onset of AMI, and 8 patients were operated from 3 days to 30 days after the onset of AMI. Eight patients had the cardiogenic shock after AMI, one had rupture of ventricular septum and cardiogenic shock, two had rupture of coronary artery after percutaneous transluminal coronary angioplasty, eight had unstable angina and frequent ventricular arrhythmia, one had ventricular fibrillation and cardiac arrest, and one had cardiac trauma. Ten patients were treated with intraaortic balloon pump (IABP). Conventional CABG was performed for 12 patients, off-pump CABG for 5 patients, and on-pump-beating CABG for 4 patients. Results Five patients died after E-CABG with a mortality of 23.8% which was obviously higher than the overall CABG mortality (23.8% vs. 3.1%, χ2=21.184, P<0.05). There were respectively 2, 2 and 1 deaths with a mortality of 33.3%, 28.6% and 12.5% respectively for operations within 6 hours, 6 hours to 3 days and 3 to 30 days after the onset of AMI. The mortality of those patients who were operated within 3 days after AMI was obviously lower (P<0.05). The primary causes of death were low cardiac output syndrome, perioperative acute myocardial infarction after CABG and sapremia. There was one death each for patients operated with off-pump and on-pump-beating CABG. Sixteeen patients were discharged from the hospital. The follow-up was from 6 months to 10 years. There were 6 late deaths among which 5 died of cardiac failure accompanied by pulmonary infection, one died of noncardiac factor. Ten patients survived at present, and the quality of life among 5 patients was unsatisfactory. Conclusion The mortality of E-CABG is obviously higher in patients operated within 3 days of AMI. With the support of IABP, if the operation can be carried out 3 days after the onset of AMI, the surgical success rate will be greatly improved by adopting proper offpump and onpumpbeating procedures.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 急性心肌梗死伴心源性休克患者应用主动脉内球囊反搏治疗的观察及护理

    【摘要】 目的 探讨使用主动脉内球囊反搏治疗过程中护理措施对改善患者预后的影响。 方法 选择我科2008年9月〖CD3/5〗2009年5月使用主动脉内球囊反搏治疗急性心肌梗死伴心源性休克的9例患者,对治疗过程进行了观察及全面合理的护理。 结果 主动脉内球囊反搏治疗患者,取得了满意的效果。 结论 主动脉内球囊反搏患者病情复杂危重,使用过程中需辅以全面合理的护理措施,防止并发症发生,对改善患者预后有益。

    Release date:2016-09-08 09:45 Export PDF Favorites Scan
  • 如何治疗主动脉瓣狭窄合并体外膜肺氧合支持下的心源性休克

    背景:患者,男,77 岁。因活动后呼吸困难及劳累性胸痛入院,完善相关检查后发现存在重度主动脉瓣狭窄及严重冠状动脉狭窄,随后行经导管冠状动脉介入治疗至右冠狭窄处植入支架。术后,患者突发心源性休克和心脏骤停,复苏后依赖于静脉-动脉体外膜肺氧合支持。检查:心电图,经胸廓的超声心动图,冠状动脉造影,计算机断层血管摄影。诊断:严重主动脉瓣狭窄合并心源性休克。治疗:为稳定患者血流动力学状态,早日拔除体外膜肺,患者被转运至导管室实施急诊经导管主动脉瓣置换术。

    Release date:2018-02-26 05:32 Export PDF Favorites Scan
  • A case report of emergency transcatheter aortic valve replacement in a patient with cardiogenic shock caused by severe aortic stenosis

    Aortic stenosis accounts for a large proportion of valvular heart disease in China. This article described an unusual case of severe aortic stenosis with severe cardiopulmonary decompensation treated by emergency transcatheter aortic valve replacement. Preoperative assessment was performed by transesophageal echocardiography. The extracorporeal membrane oxygenation team was informed to be ready. During the operation, no obvious perivalve leakage was observed after valve released. The transvalvular pressure gradient decreased to 7 mm Hg (1 mm Hg=0.133 kPa).The patient’s symptoms were completely relieved after the operation, and no adverse events occurred during the hospitalization. After discharge, color Doppler echocardiography showed that stenosis was eliminated, cardiac function was improved, no significant perivalvular leakage was observed, and pulmonary hypertension reduced to moderate. The success of this operation confirmed the efficacy of emergency transcatheter aortic valve replacement, and showed that after a rigorous evaluation, emergency transcatheter aortic valve replacement may be a reasonable choice for patients with severe aortic valve stenosis.

    Release date:2020-05-26 02:34 Export PDF Favorites Scan
  • Veno-arterial extracorporeal membrane oxygenation in salvage of cardiogenic shock

    Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.

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  • Early clinical efficacy of emergency transcatheter aortic valve replacement for severe aortic stenosis

    Objective To explore the clinical effects of emergency transcatheter aortic replacement (TAVR) on the treatment of patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis during hospitalization. Methods The study selected 44 patients from 8 heart valve centers from January 2018 to January 2021. All patients received emergency TAVR treatment. The patients’ baseline clinical data, cardiac ultrasound indicators, and postoperative hospital stay were collected. Paired t-test and McNemar test were used to compare and analyze the preoperative and postoperative cardiac ultrasound indexes, moderate to severe aortic stenosis, and cardiac function. Results The average age of the patients was (72.0±7.9) years. Valve displacement occurred in one patient during the operation, and the surgical success rate was 97.7%. Four cases died during hospitalization, and the mortality rate was 9.1%. The median length of hospital stay was 11.5 d. The postoperative aortic valve area was significantly higher than that before surgery [(0.5±0.2) vs. (3.8±1.6) mm2, P<0.05], the mean transvalvular pressure of the aortic valve was significantly lower than that before operation [(64.0±24.9) vs. (11.3±4.6) mm Hg (1 mm Hg=0.133 kPa), P<0.05], the peak aortic flow velocity was significantly lower than that before operation [(4.5±0.7) vs. (1.9±0.7) m/s, P<0.05], the left ventricular end diastolic inner diameter was lower than that before operation [(59.0±7.2) vs. (56.1±7.3) mm, P<0.05], the left ventricular ejection fraction increased significantly compared with that before operation [(30.1±10.4)% vs. (40.9±11.0)%, P<0.05], and the cardiac function improved significantly compared with that before operation (P<0.05). During the operation, 2 cases (4.5%) underwent valve-in-valve implantation, 11 cases (25.0%) underwent percutaneous coronary intervention during the same period. During the postoperative hospital stay, 1 case (2.3%) developed stroke, 3 cases (6.8%) experienced severe bleeding, 5 cases (11.4%) had severe vascular complications, 2 cases (4.5%) experienced acute myocardial infarction, 30 cases (68.2%) had small or trace paravalvular regurgitation, 3 cases (6.8%) received permanent pacemaker implantation, and 5 cases (11.4%) developed acute kidney injury. Conclustion Emergency TAVR is an effective and feasible treatment plan for patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis.

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