体外膜肺氧合对急性右心衰竭犬血流动力学的影响  

Effects of extracorporeal membrane oxygenation on hemodynamics in acute right heart failure in dogs

作　　者：郑俊波[1] 于凯江[1] 叶明[1] 王洪亮[1] 姜雪松[1] 刘海涛[1] 

机构地区：[1]哈尔滨医科大学附属第二医院ICU,黑龙江150086

出　　处：《中国危重病急救医学》2012年第4期229-232,共4页Chinese Critical Care Medicine

基　　金：黑龙江省自然科学基金重点项目（ZD200917）

摘　　要：目的探讨体外膜肺氧合（ECMO）对急性右心衰竭犬血流动力学的影响。方法体重20～25kg健康成年雄性犬10只，按随机数字表法分为急性右心衰竭模型组和ECMO治疗组，每组5只。犬麻醉后行胸廓切开术，于右心房、右心室、肺动脉放置相关测压导管，测量右心房压（RAP）、右心室压（RVP）及肺动脉压（PAP）；于主动脉及肺动脉放置血管超声探头，测量心排血量（c0）及肺动脉流量（QPA），测得结果为基础值。ECMO组建立静脉一动脉体外膜肺氧合（VA—ECMO）转流，分别经股动脉和股静脉建立动、静脉插管，随后连接预充的ECMO装置。两组均逐渐套扎肺动脉以使QPA分别降至基础值的60％、40％和0％，每降至一个程度保持30rain，并测量上述血流动力学指标，观察其变化。结果模型组与ECMO组血流动力学指标基础值比较无明显差异。套扎肺动脉后，模型组CO（L／rain）于QPA降至60％和40％时均较基础值明显下降（1．80±0．19、1．48±0．22比3．24±0．23，均P〈O．05），且显著低于ECMO组（60~QPA：1．80±0．19比3．24±0．35；40％QPA：1．48±0．22比3．20±0．37，均P〈O．05）；ECMO组CO于QPA降至60％、40％和0％时与基础值比较差异无统计学意义（3．24±0．35、3．20±0．37、3．12±0．28比3．44±0．32，均P〉O．05）。模型组PAP、RAP和RVP（均irlmHg，1mmHg=O．133kPa）于QPA降至60％和40％时均较基础值明显增加（PAP：36．2±5．3、39．8±5．4比17．4±2．7；RAP：11．2±2．8、12．8±2．6比4．4±1．7；RVP：25．6±4．9、27．8±4．5比11．6±1．8，均P〈O．05），且显著高于ECM0组（60％QPA：PAP36．2±5-3比23．2±5．2，RAP11．2±2．8比6．2±2．3，RVP25．6±4．9比15．2±3．5；40~QPA：PAP39．8±5．4比24．4±4．8，RAP12_8±2．6比7．0±2．4，RVP27．8±4．5比16．8±4．2，均P〈O．05）；而平均动脉压（MAP，mmHg）较基础值�Objective To investigate the effects of extracorporeal membrane oxygenation （ECMO） on the hemodynamics in dogs with acute fight heart failure. Methods Ten healthy adult male dogs （weighted 20-25 kg） were randomly divided into two groups： acute right heart failure group （n=-5 ） and ECMO group （n = 5 ）. Under anesthesia, dogs were underwent thoracotomy, then the catheters were placed in the right atrium, right ventricle, and pulmonary artery, for measuring the relevant pressures, including fight arterial pressure （RAP）, right ventrieular pressure （RVP）, and pulmonary artery pressure （PAP）. The vascular ultrasound probe were placed on the aorta and pulmonary artery for measuring the cardiac output （ CO ） and pulmonary artery flow rate （ QPA ）. Then, a baseline measurement was acquired. The femoral artery and femoral vein were eannulated and used for the venoarterial extracorporeal membrane oxygenation （VA-ECMO）, and then connected to extracorporeal circuit, which was initially primed. The pulmonary artery was progressively ligated to decrease blood flow until QPA was 60%, 40%, and 0% of baseline in both groups. The above flow conditions were respectively maintained for 30 minutes, after which hemodynamic data were collected. Results The baseline hemodynamic measurements were not different between acute right heart failure group and ECMOgroup. After ligating the pulmonary artery, compared with baseline, CO （L/min） decreased significantly at 60% and 40% QPA in acute right heart failure group （1.80 ±0.19, 1.48 ±0.22 vs. 3.24 ±0.23, both P〈0.05）, and significantly lower than that of ECMO group （60%QPA： 1.80 ± 0.19 vs. 3.24 ± 0.35; 40%QPA： 1.48 ± 0.22 vs. 3.20 ± 0.37, both P〈0.05 ）. CO was not significantly different from baseline in ECMO group at 60%, 40% and 0% QPA （3.24 ± 0.35, 3.20 ± 0.37, 3.12 ± 0.28 vs. 3.44 ± 0.32, all P〉0.05 ）. PAP, RAP and RVP （all mm Hg, 1 mm Hg= 0.133 kPa） were significantly elevated in acute right heart failure

关 键 词：体外膜肺氧合 右心衰竭 急性 血流动力学 犬 

分 类 号：R541.6[医药卫生—心血管疾病]