Petzina Rainer, Ugander Martin, Gustafsson Lotta, Engblom Henrik, Sjögren Johan, Hetzer Roland, Ingemansson Richard, Arheden Håkan, Malmsjö Malin
Department of Medicine, Lund University Hospital, Lund, Sweden.
J Thorac Cardiovasc Surg. 2007 May;133(5):1154-62. doi: 10.1016/j.jtcvs.2007.01.011.
The hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery are debated. The aim of the present study was to quantify cardiac output and left ventricular chamber volumes after vacuum-assisted closure using magnetic resonance imaging, which is known to be the most accurate method for quantifying these measures.
Six pigs had median sternotomy followed by vacuum-assisted closure treatment in the presence and absence of a paraffin gauze interface dressing. Cardiac output and stroke volume were examined using magnetic resonance imaging flow quantification (breath-hold and real-time). Chamber volumes were assessed using cine magnetic resonance imaging.
Cardiac output and stroke volume decreased immediately after application of negative pressures of 75, 125, and 175 mm Hg (13% +/- 1% decrease in cardiac output). Interposition of 4 layers of paraffin gauze dressing over the heart during vacuum-assisted closure therapy resulted in a smaller decrease in cardiac output (8% +/- 1%).
Vacuum-assisted closure therapy results in an immediate decrease in cardiac output, although to a lesser extent than shown previously. Covering the heart with a wound interface dressing lessens the hemodynamic effects of vacuum-assisted closure.
心脏手术中真空辅助闭合疗法的血流动力学效应存在争议。本研究的目的是使用磁共振成像来量化真空辅助闭合后的心输出量和左心室容积，磁共振成像已知是量化这些指标最准确的方法。
6头猪接受正中胸骨切开术，然后在有和没有石蜡纱布界面敷料的情况下进行真空辅助闭合治疗。使用磁共振成像血流定量（屏气和实时）检查心输出量和每搏输出量。使用电影磁共振成像评估心室容积。
施加75、125和175 mmHg负压后，心输出量和每搏输出量立即下降（心输出量下降13%±1%）。在真空辅助闭合治疗期间在心脏上放置4层石蜡纱布敷料导致心输出量下降较小（8%±1%）。
真空辅助闭合疗法导致心输出量立即下降，尽管程度比之前报道的要小。用伤口界面敷料覆盖心脏可减轻真空辅助闭合的血流动力学效应。
