静脉-静脉体外膜肺氧合联合房间隔造口术治疗右心衰竭的实验研究  

The experimental study on using of venovenous extracorporeal membrane oxygenation and atrial septostomy for right heart failure

作　　者：郑俊波[1] 温良鹤[1] 戴青青 姜雪松[1] 娄邵菲[1] 叶明[1] 于凯江[2] Zheng Jun-bo;Wen Liang-he;Dai Qing-qing;Jiang Xue-song;Lou Shao-fei;Ye Ming;Yu Kai-jiang(Intensive Care Unit, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China)

机构地区：[1]哈尔滨医科大学附属第二医院重症医学科,黑龙江哈尔滨150086 [2]哈尔滨医科大学附属第三医院重症医学科,黑龙江哈尔滨150040

出　　处：《中国急救医学》2018年第6期539-542,共4页Chinese Journal of Critical Care Medicine

基　　金：黑龙江省教育厅科学技术研究项目（12531287）

摘　　要：目的 探讨静脉-静脉体外膜肺氧合（VV-ECMO）联合房间隔造口术对急性右心衰竭犬的治疗效果。方法 随机将12只犬分为急性右心衰竭对照组（对照组，n=6）和VV-ECMO联合房间隔造口术治疗组（治疗组，n=6），麻醉后行胸廓切开术，分别放置相应测压导管以监测左心房压力（LAP）、肺动脉压力（PAP）及右心室平均压力（MRVP）。将血管流量超声探头分别置于升主动脉和肺动脉外周以测量心输出量（CO）和肺动脉流量（QPA），分别测量出基础值。治疗组在建立体外循环后进行房间隔造口术，随后将体外循环改为VV-ECMO转流。两组均逐渐套扎肺动脉使QPA分别降至基础值的60%、40%和0，每降一个程度均保持30 min，并测量血流动力学相关指标。结果 两组各种血流动力学指标基础值之间差异无统计学意义（P均〉0.05）。对照组CO于QPA降至60%和40%时明显下降，并且明显低于治疗组（P均〈0.05），治疗组CO在QPA下降过程中则无明显变化（P均〉0.05）。在QPA降至60%和40%时，两组的PAP和MRVP均明显增加，另外，对照组的LAP和MAP均明显下降（P均〈0.05），而治疗组的LAP和MAP则无明显下降。除PAP外，治疗组各项血流动力学参数在QPA降至40%时均明显优于对照组（P均〈0.05）。结论 VV-ECMO联合房间隔造口术可有效改善肺动脉阻力增高所致急性右心衰竭犬的血流动力学，为临床治疗急性右心衰竭提供了一种新的治疗选择。Objective To investigate the effectiveness of venovenous extracorporeal membrane oxygenation （VV-ECMO） with an atrial septostomy （AS）to treat acute right heart failure in dogs. Methods Twelve dogs were randomly divided into two groups： acute right heart failure control group （n=6） and VV-ECMO with AS treatment group （n=6）.After anaesthetization, dogs underwent a thoracotomy and hemodynamic instrumentation to measure cardiac output （CO）, pulmonary artery flow rate （QPA）and all relevant pressures, including left atrial pressure （LAP）, pulmonary artery pressure （PAP）and mean right ventricular pressure （MRVP）. Then, a baseline data set was collected. In VV-ECMO with AS treatment group, an AS was created during cardiopulmonary bypass, and the cardiopulmonary bypass circuit was converted into VV-ECMO circuit. The pulmonary artery was progressively occluded to decrease blood flow until QPA was 60%, 40%, and 0 of baseline in both groups.The above flow conditions were maintained for 30 minutes, after which data were recorded. Results The baseline hemodynamic measurements were not different between control group and treatment group （all P〉0.05）. CO decreased significantly at 60% and 40% QPA in control group, and significantly lower than treatment group at each flow condition （all P＜0.05）. CO was not significantly different in treatment group （all P〉0.05）. PAP and MRVP were significantly increased in both groups at 60% and 40% QPA. LAP and MAP were significantly decreased in control group （all P＜0.05）, which were not observed in treatment group. All hemodynamic measurements in treatment group were significantly superior to those in control group at 40% QPA except PAP （all P＜0.05）. Conclusion VV-ECMO with AS is capable of improving hemodynamics in dogs with high-afterload induced acute right heart failure, which may serve as a novel potential treatment option for acute right heart failure patients.

关 键 词：体外膜肺氧合(ECMO) 房间隔造口术 右心衰竭(RHF) 

分 类 号：R726.542[医药卫生—儿科]