16例左心室辅助装置植入患者围术期治疗效果观察与随访

Observation and follow-up of perioperative therapeutic effects in 16 patients with left ventricular assist device implantation

  • 摘要:
    目的 探讨16例左心室辅助装置(LVAD)植入术患者的围术期治疗效果及随访管理。
    方法 回顾性分析16例心脏外科接受LVAD植入术患者的资料。通过电子病例系统收集患者术前,术后30、60、90 d的6 min步行试验(6MWT)、欧洲五维健康量表(EQ-5D-5L)、纽约心脏病协会(NYHA)心功能分级、超声心动图、胸片、心胸比和并发症(感染、出血、血栓、右心功能衰竭、神经系统)数据。
    结果 术后90 d患者均带泵生存, 1例术前存在肾功能不全,术后行透析治疗,术后8个月行心脏移植; 1例腹壁经皮导线处出现无菌性肉芽肿,经治疗好转,其余无并发症发生。术后90 d, 右心室面积变化分数和三尖瓣环收缩位移与术前比较,差异无统计学意义(P>0.05); 左心室射血分数、左心室舒张末内径、心胸比较术前改善,差异均有统计学意义(P < 0.05); 术后30 d, 恢复到NYHA Ⅰ级的占30%, Ⅱ级的占70%; 60 d, Ⅰ级占80%, Ⅱ级占20%; 90 d, Ⅰ级占90%, Ⅱ级占10%。术后90 d内患者的6MWT和EQ-5D-5L增加,差异有统计学意义(P < 0.01)。
    结论 通过多学科LVAD团队行植入前严格评估,细化手术方式,做好LVAD植入患者住院期间管理、出院前自我管理、出院后每日随访及回院随访管理等工作,术后90 d患者的心功能及生活质量得到显著提高。

     

    Abstract:
    Objective To explore the perioperative therapeutic effects and follow-up management in 16 patients with left ventricular assist device (LVAD) implantation.
    Methods A retrospective analysis was conducted in data of 16 patients who underwent LVAD implantation in the department of cardiovascular surgery. Data of 6-minute walk test (6MWT), European Quality of Life-5 Dimension-5 Levels (EQ-5D-5L), New York Heart Association (NYHA) classification, echocardiography, chest radiography, cardiothoracic ratio, and occurrence of complications (infection, bleeding, thrombosis, right heart failure, neurological issues) were collected via the electronic medical record system before surgery and at 30, 60, and 90 days postoperatively.
    Results All patients survived with the pump at 90 days postoperatively. One patient with preoperative renal insufficiency underwent dialysis and received a heart transplant after 8 months. One patient developed a sterile granuloma at the percutaneous lead site on the abdominal wall, which improved after treatment, no complications occurred in other patients. At 90 days postoperatively, there was no statistically significant difference in the right ventricular area change fraction and tricuspid annular plane systolic excursion compared with preoperative values (P>0.05). The left ventricular ejection fraction, left ventricular end-diastolic diameter, and cardiothoracic ratio showed significant improvement compared with preoperative levels (P < 0.05). At 30 days postoperatively, 30% of patients recovered to NYHA class Ⅰ and 70% to class Ⅱ; at 60 days, 80% of patients to class Ⅰ and 20% to class Ⅱ; at 90 days, 90% to class Ⅰ and 10% to class Ⅱ. The 6MWT and EQ-5D-5L scores of patients significantly increased within 90 days postoperatively (P < 0.01).
    Conclusion Through rigorous preoperative assessment by a multidisciplinary LVAD team, refinement of surgical techniques, and comprehensive management during hospitalization, self-management before discharge, daily follow-up after discharge, and follow-up management upon returning to the hospital for patients with LVAD implantation, the cardiac function and quality of life of patients are significantly improved at 90 days postoperatively.

     

/

返回文章
返回