不同容量外置主动脉旁反搏对急性心衰的辅助效果  

Research of an extra-thoracic paraaortic counterpulsation device with various capacities in acute heart failure

作　　者：张杰民[1] 刘晓程[2] 沈德民 刘志刚[2] 刘天文[1] 张亚东[4] 王帆[1] 

机构地区：[1]泰达国际心血管病医院辅助循环研究室,天津300457 [2]泰达国际心血管病医院心脏外科,天津300457 [3]万隆神鹰医院胸心外科,印度尼西亚万隆40184 [4]泰达国际心血管病医院超声科,天津300457

出　　处：《中华胸心血管外科杂志》2016年第10期621-624,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：天津滨海新区医学基金（2012-BK15W003）

摘　　要：目的评价不同容量外置主动脉旁反搏（ETPACD）对急性心衰辅助效果。方法成年改良小尾寒羊8只，体质量35．0～42．0kg。将自制ETPACD（每搏量分别为40、60、80m1）的无瓣人工血管吻合于降主动脉，反搏泵置于胸外。结扎冠状动脉分支建立急性心衰动物模型，分别完成不同容量反搏辅助。结果ETPACD（每搏量40、60、80m1）辅助后，心输出量分别增加36．98％（P=0．009）、34．16％（P=0．012）和53．26％（P=0．000）；每搏量80ml与60m1、40ml比较分别为P=0．001，P=0．005。舒张期平均动脉压（DMAP）分别增高43．40％（P=0．000）、63．20％（P=0．000）和78．76％（P=0．000）；每搏量80ml与60m1、40ml比较分别为P=0．329，P=0．025。左侧颈动脉流量（LCAF）分别增加45．19％（P=0．007）、61．51％（P=0．001）和81．50％（P=0．000）；每搏量80ml与60ml、40ml比较分别为P=0．016，P=0．000。结论ETPACD对急性心衰动物有良好的辅助作用。增大辅助容量可进一步增加心输出量，提高舒张期平均动脉压，增加颈动脉流量，改善脑灌注。Objective The purpose of this study was to evaluate the hemodynamic effects of an extra-thoracic paraaortic counterpulsation device（ETPACD） with various capacities in an animal model with acute heart failure. Methods The acute heart failure model was successfully induced by snaring branch of anterior descending coronary artery in sheep（ weighting 35 - 42 kg, n = 8 ）. The ETPACD is a single port, 40 ml, 60 ml and 80 ml stroke volume blood chamber designed to be connected to descending aorta through a valveless graft and placed extra-thorax. The hemodynamic indices of 40 ml, 60 ml and 80 ml stroke volume were recorded respectively during counterpulsation assistance. Results 40 ml, 60 ml and 80 ml ETPACD in- creased cardiac output 36.98% （P =0. 009）, 34.16% （P =0. 012） and 53.26% （P =0. 000） respectively, 80 ml compared with 60 ml and 40 ml respectively P = 0.001, P = 0.005 . And on diastolic mean aortic pressure 43.40% （ P = 0.000 ）, 63.20% （ P = 0.000） and 78.76% （ P = 0.000 ）, 80ml compared with 60ml and 40ml respectively P = 0. 329, P = 0. 025. The ETPACD （ 40 ml, 60 ml and 80 ml ） increased left carotid artery flow 45.19 % （ P = 0. 007 ）, 61.51% （ P = 0.001 ） and 81.50% （P = 0. 000）, 80 ml compared with 60ml and 40 ml respectively P = 0. 016, P = 0. 000. Conclusion This study demonstrated that ETPACD （40 ml, 60 ml and 80 ml） provided benefit of circulatory support in acute heart failure with better effect on hemodynamic parameters provided by 80 ml. Therefore, ETPACD with larger stroke volume may become a promising counterpulsation device for treatment of heart failure.

关 键 词：心力衰竭 主动脉旁反搏 心脏辅助装置 

分 类 号：R541.6[医药卫生—心血管疾病]