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首页> 外文期刊>Journal of cardiac surgery. >Perioperative care in left ventricular volume reduction.
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Perioperative care in left ventricular volume reduction.

机译：左室容积减少的围手术期护理。

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BACKGROUND: While the operative technique of left ventricular volume reduction (LVVR) is rapidly becoming standardized, the optimal perioperative management strategy is yet to be determined. We present our experience with the care of patients undergoing LVVR. METHODS: LVVR was performed in 21 patients (mean age = 65.5 years) with congestive heart failure. Our management strategy was initially based on afterload reduction with sodium nitroprusside, but was later modified to include routine preoperative intra-aortic balloon support, normothermic cardiopulmonary bypass, antegrade intermittent warm blood cardioplegia, and postoperative support with phosphodiesterase-III inhibitors. Hemodynamic manipulations are aimed to attain systemic vascular resistance between 600 and 800 dyne/sec per cm(-5) and the lowest mean blood pressure that is able to maintain satisfactory systemic perfusion. Postoperatively, aggressive antifailure medical therapy with a high dose of angiotensin converting enzyme inhibitors, nitrates, and diuretics was initiated early and maintained indefinitely. RESULTS: Using this approach, postoperative progress was characterized by hemodynamic stability. IABP support was used for 59.6+/-9 hours following surgery, and inotropic support for 103+/-12 hours. In our series there were four (19%) in-hospital deaths, two of which were related to heart failure. CONCLUSION: The described approach is associated with an acceptable early outcome. However, further advances in myocardial protection methods and pharmacological and mechanical support techniques are necessary for a wider adoption of this procedure.
机译：背景：左室减容（LVVR）的手术技术正在迅速标准化，但最佳围手术期管理策略尚待确定。我们将介绍我们在接受LVVR的患者护理方面的经验。方法：LVVR是在21例平均年龄为65.5岁的充血性心力衰竭患者中进行的。我们的管理策略最初是基于硝普钠降低后负荷，但后来进行了修改，包括常规术前主动脉内球囊支持，正常体温心肺分流术，顺行性间歇性温血性心脏停搏，以及术后使用磷酸二酯酶-III抑制剂的支持。血流动力学操纵的目的是使全身血管阻力达到600至800达因/秒/ cm（-5），并使最低血压能够保持令人满意的全身灌注。术后早期就开始使用高剂量的血管紧张素转化酶抑制剂，硝酸盐和利尿剂进行积极的抗失败药物治疗，并无限期维持。结果：使用这种方法，术后进展的特点是血液动力学稳定。 IABP支持手术后59.6 +/- 9小时，而正性肌力支持103 +/- 12小时。在我们的系列研究中，有4例（19％）的院内死亡，其中2例与心力衰竭有关。结论：所描述的方法与可接受的早期结果相关。但是，心肌保护方法以及药理和机械支持技术的进一步发展对于更广泛地采用该方法是必要的。

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