主动脉内球囊反搏可改善急性缺血性右心室衰竭的血流动力学及右心室效率。

Intraaortic balloon pumping improves hemodynamics and right ventricular efficiency in acute ischemic right ventricular failure.

作者信息

Nordhaug Dag, Steensrud Tor, Muller Stig, Husnes Kjell Vidar, Myrmel Truls

机构信息

Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway.

出版信息

Ann Thorac Surg. 2004 Oct;78(4):1426-32. doi: 10.1016/j.athoracsur.2003.12.077.

DOI:10.1016/j.athoracsur.2003.12.077

PMID:15464508

Abstract

BACKGROUND

Left ventricular unloading has a potentially deleterious effect in right ventricular failure as a result of altered septal interplay. However, a positive effect of an intraaortic balloon pump during right ventricular failure has been suggested. We investigated the impact of intraaortic balloon pumping on hemodynamics and both left and right ventricular function in an experimental model of isolated right ventricular failure.

METHODS

Sixteen anesthetized pigs (25 to 34 kg) were used in an in vivo model. Pressure-conductance catheters assessed right and left ventricular pressure-volume relationships. Acute right ventricular failure was induced by right coronary microembolization, and led to severely impaired right ventricular function, reduced cardiac output and arterial pressure, and an increased pulmonary vascular resistance and pulmonary arterial elastance. Animals were then randomized to balloon pump or control groups and evaluated with respect to hemodynamics and ventricular function after 1 hour.

RESULTS

Intraaortic balloon pumping did not alter right or left ventricular contractility. However, balloon pump-treated animals had significantly improved cardiac output (+18% +/- 18% versus -6% +/- 7%; p = 0.003) and mean arterial pressure (+36% +/- 30% versus -7% +/- 14%; p = 0.004) compared with controls. Animals in the balloon pump group had lower pulmonary vascular resistance (795 +/- 63 versus 912 +/- 259 dynes . sec . cm(-5); p < 0.01) and pulmonary arterial elastance (1.14 +/- 0.20 versus 1.69 +/- 0.65 mm Hg/mL; p < 0.01), and increased stroke volume (22.3 +/- 4.7 versus 17.9 +/- 4.7 mL; p = 0.016). Right ventricular efficiency was also improved in the balloon pump group (stroke work per pressure-volume area = 0.60 +/- 0.14 versus 0.41 +/- 0.12; p < 0.01).

CONCLUSIONS

Intraaortic balloon pump support does not alter right or left ventricular function in acute right ventricular failure. However, arterial pressure, cardiac output, and right ventricular efficiency are improved, possibly because of a balloon pump-induced reduction in pulmonary arterial resistance.

摘要

背景

由于室间隔相互作用改变，左心室卸载对右心室衰竭可能产生有害影响。然而，有人提出主动脉内球囊反搏在右心室衰竭期间具有积极作用。我们在孤立性右心室衰竭的实验模型中研究了主动脉内球囊反搏对血流动力学以及左、右心室功能的影响。

方法

在一个体内模型中使用了16只麻醉猪（体重25至34千克）。压力-导纳导管评估右心室和左心室的压力-容积关系。通过右冠状动脉微栓塞诱导急性右心室衰竭，导致右心室功能严重受损、心输出量和动脉压降低，以及肺血管阻力和肺动脉弹性增加。然后将动物随机分为球囊反搏组或对照组，并在1小时后评估血流动力学和心室功能。

结果

主动脉内球囊反搏未改变右心室或左心室的收缩性。然而，与对照组相比，接受球囊反搏治疗的动物心输出量显著改善（+18%±18%对-6%±7%；p = 0.003），平均动脉压显著改善（+36%±30%对-7%±14%；p = 0.004）。球囊反搏组动物的肺血管阻力较低（795±63对912±259达因·秒·厘米⁻⁵；p < 0.01），肺动脉弹性较低（1.14±0.20对1.69±0.65毫米汞柱/毫升；p < 0.01），每搏量增加（22.3±4.7对17.9±4.7毫升；p = 0.016）。球囊反搏组的右心室效率也有所提高（每压力-容积面积的搏功 = 0.60±0.14对0.41±0.12；p < 0.01）。