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- Surgical Treatments for Low Cardiac Output Patients
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題 名 | Surgical Treatments for Low Cardiac Output Patients=低心輸出量的外科治療 |
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作 者 | 周迺寬; 趙安怡; 許榮彬; 陳益祥; 詹國禎; 王水深; 朱樹勳; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 3:1 2001.01[民90.01] |
頁 次 | 頁82-89 |
分類號 | 416.262 |
關鍵詞 | 低心輸出量; 左心室減容術; 機械循環輔助器; 心臟移植; Low cardiac output; Partial left ventriculectomy; Mechanical circulatory support; Cardiac transplantation; |
語 文 | 英文(English) |
中文摘要 | 開心手術心肺循環後,心臟功能要很小心的照顧才能恢復。為了防止出現“低心輸出量”的發生,對於心跳、心律、血容比、前負載、後負載,都必須小心地、有效地、快速地調整到正常範圍內。同時,也必須排除心臟尚有結構上的缺陷,如:瓣膜仍存在逆流或是狹窄,動靜脈血液分流仍存在,這些解剖結構缺陷所造成低心輸出量,必須先完全矯正,才能使心臟功能恢復。另外,手術出血以及出血後大量血塊造成的心包膜填塞是外科醫師必須迅速第一線就確實診斷出來,才可以馬上排除造成“低心輸出量”的危險因子。如果以上的因素都排除,低心輸出量症狀仍持續,此時,才需要進一步的外科治療方法如:左心室減容術、機械循環輔助如:主動脈氣球幫浦及心室輔助器和心臟移植,依時、依人、依病,因而決定其最適當外科治療方法。 |
英文摘要 | Following cardiopulmonary bypass, a series of steps can usually be used to restore function to the heart. A low cardiac output can be countered with a response checklist that includes adjusting heart rate, correcting cardiac arrhythmia, ensuring adequate hematocrit, adjusting preload and afterload, and stimulating cardiac contractility. It is the surgeon’s responsibility to make a thorough investigation of any structural abnormality that may contribute to the low cardiac output state; adequate repair of cardiac defects will often result in an improved hemodynamic stage. Hemorrhage is an important cause of poor cardiac performance. Tamponade of the heart is usually due to retained clots associated with hemorrhage after operation and is indicated by a low cardiac output with equalization and elevation of atrial pressures. In a low cardiac output, post-surgical stage, the possibility of residual shunts and obstructions, inadequate valve repair, and closure or inadequate flow through a graft may need to be investigated. Partial left ventriculectomy should be performed in some refractory low cardiac output patients. Once that has been achieved, the appropriate steps can be taken to improve cardiac performance. If the hemodynamic state is no stable, and the patient persists with low cardiac output, advanced surgical treatments for mechanical circulatory support should be considered. There are intra-aortic balloon pump, extracorporeal membrane oxygenation (ECMO), ventricular assist devices and total artificial heart. |
本系統中英文摘要資訊取自各篇刊載內容。