主动脉内气囊反搏对体外膜式氧合患者不同区域微循环状态的影响  

The effect of intra-aortic balloon pump on microcirculation of different area in patients supported by extracorporeal membrane oxygenation

作　　者：杜中涛[1] 邢智辰[1] 杨峰[1] 江春景[1] 徐博[1] 李蛟[1] 邢家林[1] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科危重症中心体外循环与机械辅助循环科,100029

出　　处：《心肺血管病杂志》2015年第12期904-907,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项项目(首发2014-1-1051)

摘　　要：目的:研究主动脉内气囊反搏(IABP)在经股动静脉体外膜式氧合(ECMO)患者中对四肢不同区域微循环状态的影响。方法:采用前瞻性、观察性研究,选取因为心源性休克而使用经股动静脉ECMO辅助联合使用IABP患者14例,使用近红外光谱分析(NIRS)在四肢进行血管阻断实验观察IABP开启与关闭时对于微循环状态及血流动力学的影响。IABP使用时以及IABP停止30分钟后分别记录心率、血压、周围组织血氧去饱和斜率及再饱和斜率等试验数据。结果:停止IABP后患者动脉舒张压[(53.86±8.65)vs.(63.29±9.54)mm Hg,P=0.001(1mm Hg=0.133k Pa)]升高,脉压差[(28.14±13.96)vs.(17.93±10.41)mm Hg,P=0.001]降低,患者四肢不同区域的组织氧饱和度(St O2)和组织血氧去饱和斜率及再饱和斜率在IABP使用与停止时没有明显改变。结论:IABP的应用产生的搏动灌注没有明显影响ECMO患者不同区域微循环状态。Objective： This study was designed to assess the effects on different areas of microcirculation of adding an intra-aortic balloon pump（ IABP） to peripheral venoarterial extracorporeal membrane oxygenation（ ECMO） patients. Methods： A prospective observational study,we selected 14 patients because of cardiogenic shock using the peripheral venoarterial ECMO combination with IABP assist. Near-infrared spectroscopy（ NIRS） with vascular occlusion test was run to observe the effect of IABP on microcirculation and hemodynamics. Heart rate,blood pressure,blood oxygen desaturation slope and resaturation slope were recorded. Results： Stopping IABP was associated with higher diastolic blood pressure [（ 53. 86 ± 8. 65） vs.（ 63. 29 ±9. 54） mm Hg（ 1mm Hg = 0. 133 k Pa）,P = 0. 001],decreased pulse pressure[（ 28. 14 ± 13. 96） vs.（ 17. 93 ±10. 41） mm Hg,P = 0. 001]. The results of NIRS that detected from thenar eminence and limb were unchanged by stopping and restarting IABP. Conclusion： IABP restored pulsatility but did not affect different areas microcirculation variables in patients with peripheral venoarterial ECMO.

关 键 词：体外膜式氧合 主动脉内气囊反搏 微循环 心源性休克 

分 类 号：R54[医药卫生—心血管疾病]