Application Of Mechanical Assist Device In Cardiac Surgery During The Perioperative Period And Clinical Nutrition Management

ObjectiveTo retrospectively analyze the application of extracorporeal membrane oxygenation(ECMO)combined with intra-aortic balloon counterpulsation in cardiac surgery during the perioperative period and corresponding clinical nutrition support therapy,aiming to explore the clinical effect of mechanical assist device in adult cardiac surgery during the perioperative period and the appropriate clinical nutrition support therapy,so as to improve the survival rate of patients with severe heart diseases.Methods1.ECMO combined with intra-aortic balloon counterpulsationThe clinical data of 38 patients undergoing ECMO combined with intra-aortic balloon counterpulsation were collected.Mean arterial pressure,central venous pressure,lactose in the blood,mixed venous oxygen saturation and use of positive inotropic drugs in different periods were analyzed.2.Nutritional therapy during ECMOThe clinical data of 60 patients receiving ECMO were collected,including the cause of ECMO,the type of ECMO,nutritional support and the use of nasal-jejunum nutrient canal.All patients were followed up.The length of ICU stay,discharge conditions and survival rate were evaluated after the withdrawal of ECMO machine.Results 1.ECMO combined with intra-aortic balloon counterpulsationIn the weaning group,longer mechanical support was associated with the improvement in mean arterial pressure,central venous pressure,lactose in the blood,mixed venous oxygen saturation and use of positive inotropic drugs.In the non-weaning group,mechanical support for a long time improved mean arterial pressure,central venous pressure,lactose in the blood and use of positive inotropic drugs,but no obvious improvement was found in mixed venous oxygen saturation.Among them,mechanical assist device was successfully withdrawn in 24 patients,and 16 patients survived and were discharged.The incidence of renal failure in the death group was significantly higher than that in the survival group,with statistical significance.2.Nutritional therapy during ECMOAmong them,50 patients received enteral nutrition therapy,14 patients underwent parenteral nutrition therapy,and 12 patients were treated with both enteral and parenteral nutrition therapy.In addition,enteral nutrition was treated as the only source of nutrition in 38 patients,and parenteral nutrition as the only source of nutrition in 2 patients.The average nutritional adequacy of protein supplements reached 58%(SD,29%)in all patients,55.4%(SD,29.7%)in patients with V-A ECMO,and 61.2%(SD,29.1%)in patients with ECMO.The average nutritional adequacy of energy supplements reached 79.9%(SD,18.3%)in all patients,72.6%(SD,23.6%)in patients with V-A ECMO,and 87.2%(SD,5.9%)in patients with V-V ECMO.Conclusion 1.Application of ECMO or intra-aortic balloon counterpulsation alone in cardiac surgery during the perioperative period cannot obtain satisfactory efficacy.These 2 methods can be combined to improve successful rescue.At the same time,related complications should be actively prevented and treated to improve prognosis.2.Patients undergoing ECMO are tolerant to enteral nutrition.The type of ECMO will not influence nutrition support therapy.Severe patients receiving ECMO are not contraindication of enteral nutrition support therapy.