每日一题_2022.07.27

A 54-year-old man presents with advanced heart failure. He had a left ventricular assist device placed two days ago as a bridge to transplantation. His intraoperative course（术中过程） was uneventful（平静的） and he was extubated 24 hours ago. His pump speed has remained at 9,600 revolutions/min. Power has remained at 5.7 watts. His last documented flow was 4.8 L/min. His heart has remained in normal sinus rhythm. The on-duty physician is called to the bedside by the nurse, who has now noted an acute decrease in cardiac output (pump flow). There have been no complications with the left ventricular assist device machinery or connections.

Which of the following findings would be consistent with the emergent situation of cardiac tamponade（心包填塞）?

答案解析：

与药物治疗相比，使用植入式左心室辅助装置 (LVAD) 治疗的晚期心力衰竭患者的生存率和生活质量得到改善。LVAD 目前被视为心脏移植的桥梁和最终治疗。随着这些设备在社区中的更高流行率，重症监护医师了解其基础知识非常重要。将流入套管（血液-器械）插入左心室尖部。将出液套管（血液至患者）插入升主动脉或降主动脉。在手术室和 ICU 滴定具有可编程变量的泵速。在术后即刻，并发症包括出血、低血容量、心律失常、血栓形成、流入套管“抽吸”事件、器械错位和右侧心力衰竭。后期并发症包括感染、血栓形成和驱动线/机器问题。在 ICU 解决这些早期并发症需要对可用的血流动力学参数进行全面审查，审查右侧心脏生理学，并密切评价超声心动图结果。在该病例中，床旁超声心动图清楚地显示了右心室压迫和与填塞一致的生理参数。

正确答案：B