Solomon Steven B, Minneci Peter C, Deans Katherine J, Feng Jing, Eichacker Peter Q, Banks Steven M, Danner Robert L, Natanson Charles, Solomon Michael A
Department of Critical Care Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Crit Care Med. 2009 Jan;37(1):7-18. doi: 10.1097/CCM.0b013e31818727bf.
Fluid refractory septic shock can develop into a hypodynamic cardiovascular state in both children and adults. Despite management of these patients with empirical inotropic therapy (with or without a vasodilator), mortality remains high.
The effect of cardiovascular support using intra-aortic balloon counterpulsation was investigated in a hypodynamic, mechanically ventilated canine sepsis model in which cardiovascular and pulmonary support were titrated based on treatment protocols.
Each week, three animals (n = 33, 10-12 kg) were administered intrabronchial Staphylococcus aureus challenge and then randomized to receive intra-aortic balloon counterpulsation for 68 hrs or no intra-aortic balloon counterpulsation (control). Bacterial doses were increased over the study (4-8 x 10(9) cfu/kg) to assess the effects of intra-aortic balloon counterpulsation during sepsis with increasing risk of death.
Compared with lower bacterial doses (4-7 x 10(9) colony-forming units/kg), control animals challenged with the highest dose (8 x 10(9) colony-forming units/kg) had a greater risk of death (mortality rate 86% vs. 17%), with worse lung injury ([A - a]O2), and renal dysfunction (creatinine). These sicker animals required higher norepinephrine infusion rates to maintain blood pressure (and higher FIO2) and positive end-expiratory pressure levels to maintain oxygenation (p < or = 0.04 for all). In animals receiving the highest bacterial dose, intra-aortic balloon counterpulsation improved survival time (23.4 +/- 10 hrs longer; p = 0.003) and lowered norepinephrine requirements (0.43 +/- 0.17 microg/kg/min; p = 0.002) and systemic vascular resistance index (1.44 +/- 0.57 dynes/s/cm5/kg; p = 0.0001) compared with controls. Despite these beneficial effects, intra-aortic balloon counterpulsation was associated with an increase in blood urea nitrogen (p = 0.002) and creatinine (p = 0.12). In animals receiving lower doses of bacteria, intra-aortic balloon counterpulsation had no significant effects on survival or renal function.
In a canine model of severe septic shock with a low cardiac index, intra-aortic balloon counterpulsation prolongs survival time and lowers vasopressor requirements.
难治性感染性休克在儿童和成人中均可发展为低动力性心血管状态。尽管对这些患者采用经验性的强心治疗（加用或不加用血管扩张剂），但死亡率仍然很高。
在一个低动力、机械通气的犬类脓毒症模型中研究主动脉内球囊反搏对心血管的支持作用，该模型中根据治疗方案调整心血管和肺部支持措施。
每周对三只动物（n = 33，体重10 - 12千克）进行支气管内金黄色葡萄球菌攻击，然后随机分为接受68小时主动脉内球囊反搏组或不接受主动脉内球囊反搏组（对照组）。在研究过程中增加细菌剂量（4 - 8×10⁹ cfu/kg），以评估在死亡风险增加的脓毒症期间主动脉内球囊反搏的效果。
与较低细菌剂量（4 - 7×10⁹ 菌落形成单位/千克）相比，接受最高剂量（8×10⁹ 菌落形成单位/千克）攻击的对照组动物死亡风险更高（死亡率86% 对17%），肺损伤（[A - a]O₂）更严重，肾功能障碍（肌酐）更明显。这些病情较重的动物需要更高的去甲肾上腺素输注速率来维持血压（以及更高的FIO₂）和呼气末正压水平来维持氧合（所有p≤0.04）。在接受最高细菌剂量的动物中，与对照组相比，主动脉内球囊反搏改善了生存时间（延长23.4±10小时；p = 0.003），降低了去甲肾上腺素需求量（0.43±0.17微克/千克/分钟；p = 0.002）和全身血管阻力指数（1.44±0.57达因/秒/厘米⁵/千克；p = 0.0001）。尽管有这些有益作用，但主动脉内球囊反搏与血尿素氮升高（p = 0.002）和肌酐升高（p = 0.12）有关。在接受较低剂量细菌的动物中，主动脉内球囊反搏对生存或肾功能无显著影响。
在心脏指数较低的严重感染性休克犬模型中，主动脉内球囊反搏可延长生存时间并降低血管升压药需求量。
