心室辅助装置植入后泵速对主动脉瓣功能状态的影响  

Effect of pump speed on functional status of aortic valve after left ventricular assist device implantation

作　　者：臧贻锐 于鑫溢 史健玮 张杰民[1] 刘志刚[1] Zang Yirui;Yu Xinyi;Shi Jianwei;Zhang Jiemin;Liu Zhigang(Department of Cardiovascular Surgery,TEDA International Cardiovascular Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300457,China)

机构地区：[1]中国医学科学院北京协和医学院泰达国际心血管病医院心血管外科,天津300457

出　　处：《中华实验外科杂志》2022年第4期679-681,共3页Chinese Journal of Experimental Surgery

基　　金：国家重点研发计划(2017YFC0111005);天津市自然科学基金(18JCZDJC36200)。

摘　　要：目的探讨连续血流左心室辅助装置(CF-LVAD)植入后泵速对主动脉瓣功能状态的影响和预测价值。方法以4例小尾寒羊为研究对象构建动物模型,将心率控制在50~100次/分,以2000 r/min为初始泵速,以50~100 r/min为增量改变泵速。多通道生理记录仪、双通道超声流量仪和心脏超声分别记录心率、主动脉压、中心静脉压、左心室收缩压、人工血管流量、主动脉瓣功能状态等。根据主动脉瓣功能状态将观测值分为主动脉瓣开放(AVO)组与主动脉瓣关闭(AVC)组,并进行Durbin-Watson检验。组间比较采用Wilcoxon秩和检验或两独立样本t检验。通过Logistic回归构建模型。通过受试者工作特征曲线(ROC)和曲线下面积(AUC)分析泵速对CF-LVAD植入后主动脉瓣功能状态的鉴别意义。结果实验过程共计产生52个观测值,AVO组共33例,AVC组共19例。研究显示,在心率一致的情况下,泵速的增加导致AVC的风险加大。统计分析显示,AVC组的泵速高于AVO组[2450.00(2400.00,2550.00)r/min比2400.00(2300.00,2475.00)r/min,Z=-2.314,P<0.05]。Logistic回归模型提示随泵速的增加,AVC的风险加大(比值比>1)。ROC曲线分析显示,泵速对CF-LVAD植入后主动脉瓣功能状态的鉴别有意义(AUC=0.691,95%置信区间=0.548~0.812,P<0.05)。结论CF-LVAD植入后,泵速对主动脉瓣功能状态的鉴别有意义。Objective Acute animal experiment was performed to observe and discuss the effect and predictive value of pump speed on aortic valve function after continuous-flow left ventricular assist device(CF-LVAD)implantation.Methods CF-LVAD model was established in 4 small-tail Han sheep.The heart rate(HR)of the model animals was controlled at 50-100 beats/min.The initial pump rate was 2000 r/min,and gradually increased by 50-100 r/min per time.Multi-channel physiological recorder,double-channel ultrasonic flowmeter and color ultrasonic device were run to record HR,aortic pressure,central venous pressure,left ventricular systolic pressure,real-time artificial vascular blood flow,and aortic valve function respectively.According to the functional status of the aortic valve,the observations were divided into aortic valve opening(AVO)group and aortic valve closure(AVC)group after the Durbin-Watson test,and the Wilcoxon rank sum test or two independent sample t test was used for comparison between the groups.The model was built by Logistic regression.The differential significance of pump speed after CF-LVAD implantation was analyzed through receiver operator characteristic(ROC)curve and area under the ROC curve(AUC)analysis.Results A total of 52 sets of observations were generated during the experiment,which were classified into 33 cases of AVO and 19 cases of AVC.Observational studies showed that under the same HR,the risk of AVC increased with pump speed.Statistical analysis showed that the pump speed in AVC group was quicker than that in AVO group[2450.00(2400.00,2550.00)r/min vs.2400.00(2300.00,2475.00)r/min,Z=-2.314,P<0.05].Logistic regression model suggested that the risk of AVC increased with the increase of pump speed(odds ratio>1).The ROC analysis showed that pump speed was significant in the differentiation of aortic valve function status after CF-LVAD implantation(AUC=0.691,95%confidence interval=0.548-0.812,P<0.05).Conclusion After CF-LVAD implantation,pump speed is significant for the identification of aortic valv

关 键 词：左心室辅助装置 主动脉瓣 

分 类 号：R654.2[医药卫生—外科学]