房间隔造口术联合体外膜肺治疗急性呼吸窘迫综合征的大动物实验研究  

A large animal study of atrial septostomy combined with extracorporeal membrane oxygenation in the treatment of acute respiratory distress syndrome

作　　者：刁力为 李温斌 师启众[3] 张保全[3] 樊宏哲[3] 刘诫[3] 李阳阳 杨英杰 吴本清 吴一彬 DIAO Liwei;LI Wenbin;SHI Qizhong;ZHABNG Baoquan;FAN Hongzhe;LIU Jie;LI Yang;YANG Yingjie;WU Benqing;WU Yibing(Shenzhen Hospital,University of Chinese Academy of Sciences,Shenzhen 518000,China)

机构地区：[1]中国科学院大学深圳医院(光明),518000 [2]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外科 [3]新乡医学院第三附属医院

出　　处：《心肺血管病杂志》2020年第3期223-227,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：中国科学院大学深圳医院(光明)院级科研重点项目资助。

摘　　要：目的:探索房间隔造口术(ASD)联合体外膜肺(ECMO)治疗急性呼吸窘迫综合症(ARDS)的效果,以便为治疗新型冠状病毒肺炎(COVID-19)重症患者寻找一条有效的新方法。方法:应用静脉泵入脂多糖(LPS)方法制作成年绵羊的ARDS大动物模型5只,在全麻体外循环下完成房间隔缺损(1~2 cm),在应用体外循环机模拟静脉-静脉体外膜肺(VV-ECMO)工作状态下,对比观察在ASD闭合和开放状态下动物的外周血氧合情况和体循环状态,以及心脏功能情况,评价ASD分流对改善心肺功能的意义。结果:在闭合ASD的情况下,未见房水平分流,仅应用VV-ECMO辅助下可见动物吸入100%氧的情况下心率(93±26)次/min,平均血压(MAP):(51.6±16.5)mmHg(1 mmHg=0.133 kPa),肺动脉压(PAP):(27.3±14.5)mmHg,肺血管阻力指数(PVRI):(47.6±9.6)N·s·m^-2·L^-1,外周动脉PaO2为(134.2±21.3)mmHg,SaO2:(96.3±0.3)%,氧合指数(PaO2/FiO2)为335.0±53.3,心脏饱胀,运动幅度较小,显得无力;在其他实验条件不变的情况下,仅打开ASD后房水平出现右向左分流,平均血压(MAP):(70.4±18.2)mmHg,PAP:(19.1±9.3)mmHg, PVRI:(32.1±8.1)N·s·m^-2·L^-1,外周动脉PaO2明显上升至(171.1±22.2)mmHg,SaO2:(98.2±0.3)%, PaO2/FiO2为427.5±55.5,心率(77±18)次/min,心脏运动幅度明显加大,心脏跳动显得轻松,体循环状态明显好转。统计学分析显示:与ASD关闭时比较,在ASD开放后MAP, PaO2, SaO2, PaO2/FiO2明显上升;PAP,PVRI明显下降。二者之间存在明显差异(P<0.01)。结论:房间隔造口术联合VV-ECMO是治疗ARDS的一种有效方法,对于COVID-19引起的重症ARDS治疗有一定的借鉴意义,需要临床应用进一步验证。Objective: to explore the effect of atrial septal defect(ASD) combined with extracorporeal membrane oxygenation(ECMO) in the treatment of acute respiratory distress syndrome(ARDS),and to find an effective new method to treat the severe case of COVID-19. Methods: 5 animal models of Pulmonary Edema in sheep were established by intravenous injection of ipopolysaccharide(LPS), after 1-2 cm ASD was completed under general anesthesia and VV-ECMO was simulated by extracorporeal circulation machine, the oxygenation of peripheral blood, systemic circulation and cardiac function were observed under closed and opened ASD, and the significance of ASD shunt in improving cardiopulmonary function was evaluated. Results: With ASD closed, no the atrial shunts appeared. Heart rate was(93±26)times/min, mean blood pressure was(51.6±16.5)mmHg, PAP was(27.3±14.5)mmHg, PVRI was(47.6±9.6)N·S·M^-2·L^-1, PaO2 of peripheral artery was(134.2±21.3)mmHg, SAO2:(96.3±0.3)%, PaO2/FiO2 was 335.0±53.3, the heart was full, the motion amplitude was small and it appeared weak, mean Blood Pressure(MAP):(70.4±18.2)mmHg, PAP:(19.1±9.3)mmHg, PVRI:(32.1±8.1)N·S·M^-2·L^-1, peripheral arterial PAO2 increased significantly to(171.1±22.2)mmHg, SAO2:(98.2±0.3)%, oxygenation index PaO2/FiO2 was 427.5±55.5, heart rate(77±18)beats/min, the range of cardiac motion was obviously increased, the heart beat was relaxed, and the systemic circulation was obviously improved. Compared with ASD closure, MAP, PaO2, SaO2, PaO2/FiO2 increased significantly and PAP, PVRI decreased significantly after ASD opening. Conclusions: Atrial Septostomy combined with VV-ECMO is an effective method to treat ARDS, which has certain reference significance to the treatment of severe ARDS caused by COVID-19, and needs further verification in clinical application.

关 键 词：2019新型冠状病毒肺炎 急性呼吸窘迫综合征 房间隔造口术 体外膜肺 大动物实验 

分 类 号：R54[医药卫生—心血管疾病]