Son H S, Sun K, Fang Y H, Park S Y, Hwang C M, Park S M, Lee S H, Kim K T, Lee I S
Department of Thoracic and Cardiovascular Surgery, Korea University, Seoul, Korea.
Int J Artif Organs. 2005 Jun;28(6):609-16. doi: 10.1177/039139880502800610.
In sudden cardiac arrest, the effective maintenance of coronary artery blood flow is of paramount importance for myocardial preservation as well as cardiac recovery and patient survival. The purpose of this study was to directly compare the effects of pulsatile versus non-pulsatile circulation to coronary artery flow and myocardial preservation in a cardiac arrest condition.
A cardiopulmonary bypass circuit was constructed in a ventricular fibrillation model using fourteen Yorkshire swine weighing 25-35 kg each. The animals were randomly assigned to group I (n=7, non-pulsatile centrifugal pump) or group II (n=7, pulsatile T-PLS pump). Extracorporeal circulation was maintained for two hours at a pump flow of 2 L/min. The left anterior descending coronary artery flow was measured with an ultrasonic coronary artery flow measurement system at baseline (before bypass) and at every 20 minutes after bypass. Serologic parameters were collected simultaneously at baseline, 1 hour, and 2 hours after bypass in the systemic arterial and coronary sinus venous blood. The Mann-Whitney U test of STATISTICA 6.0 was used to determine intergroup significances using a p value of <0.05.
The resistance index of the coronary artery was lower in group II and the difference was significant at 40 min, 80 min, 100 min and 120 min (p<0.05). The mean velocity of the coronary artery was higher in group II throughout the study, and the difference was significant from 20 min after starting the pump (p<0.05). The coronary artery blood flow was higher in group II throughout the study, and the difference was significant from 40 min to 120 min (p<0.05) except at 80 min. Serologic parameters showed no differences between the groups at 1 hour and 2 hours after bypass in the systemic and coronary sinus blood (p=NS).
In the cardiac arrest condition, pulsatile extracorporeal circulation provides more blood flow, higher flow velocity and less resistance to coronary artery than non-pulsatile circulation.
在心脏骤停时，有效维持冠状动脉血流对于心肌保护、心脏恢复及患者存活至关重要。本研究的目的是在心脏骤停状态下，直接比较搏动性循环与非搏动性循环对冠状动脉血流及心肌保护的影响。
使用14只体重25 - 35千克的约克郡猪构建心室颤动模型中的体外循环回路。动物被随机分为I组（n = 7，非搏动性离心泵）或II组（n = 7，搏动性T - PLS泵）。以2升/分钟的泵流量维持体外循环两小时。在基线（体外循环前）及体外循环后每20分钟，用超声冠状动脉血流测量系统测量左前降支冠状动脉血流。在体外循环基线、1小时及2小时时，同时采集体循环动脉血和冠状窦静脉血中的血清学参数。使用STATISTICA 6.0的曼 - 惠特尼U检验，以p值<0.05确定组间差异的显著性。
II组冠状动脉阻力指数较低，在40分钟、80分钟、100分钟和120分钟时差异显著（p<0.05）。在整个研究过程中，II组冠状动脉平均速度较高，从泵启动后20分钟起差异显著（p<0.05）。在整个研究过程中，II组冠状动脉血流较高，除80分钟外，从40分钟至120分钟差异显著（p<0.05）。血清学参数显示，在体外循环后1小时和2小时，体循环和冠状窦血中两组间无差异（p = 无显著性差异）。
在心脏骤停状态下，搏动性体外循环比非搏动性循环能为冠状动脉提供更多血流、更高流速及更低阻力。
