Jung Christian, Lauten Alexander, Rödiger Christoph, Krizanic Florian, Figulla Hans R, Ferrari Markus
Friedrich-Schiller-University, Clinic of Internal Medicine I, Jena, Germany.
Perfusion. 2009 Nov;24(6):417-21. doi: 10.1177/0267659109358208.
Intra-aortic balloon counter-pulsation (IABP) is recommended for hemodynamic support in cardiogenic shock. In addition, it can be applied during high-risk percutaneous interventions (PCI). While IABP support improves microflow in cardiogenic shock, its effect in hemodynamically stable patients is still unclear. We, therefore, sought to evaluate the effect of IABP treatment on microflow in hemodynamically stable patients undergoing elective high-risk PCI.
In six patients with >50% left main stenosis, microflow was evaluated according to current guidelines, using side-stream dark-field microscopy, visualizing microcirculatory vessels without using fluorescent dyes. Microflow was analyzed separately for each vessel category (diameter: 10-25microm and 26-50microm), using a semiquantitative system (0= no flow; 1= intermittent flow; 2= sluggish flow; 3= continuous flow) by a trained investigator. Steady state recordings and additional recordings twenty seconds after discontinuation of the electively implanted IABP were acquired.
Microflow in vessel categories 10-25microm and 26-50microm increased in this group of hemodynamically stable patients on use of IABP. Microflow decreased from 2.73 + or - 0.39 (p=0.052; 26-50microm: 2.88 + or - 0.20, p=0.008) to 2.22 + or - 0.23 (2.18 + or - 0.45) after stopping the IABP and increased to 2.90 + or - 0.14 (p=0.009; 2.85 + or - 0.28, p=0.009) after restart of the IABP.
Circulatory support with IABP increases microcirculatory flow in the smallest vessels of the sublingual mucosa. Our data support the hypothesis that intra-aortic balloon counter-pulsation increases coronary and microvascular perfusion, thus, improving microcirculation even in hemodynamically stable patients. The use of IABP may increase safety of complex PCI and decrease the risk of deleterious complications.
主动脉内球囊反搏（IABP）被推荐用于心源性休克的血流动力学支持。此外，它可应用于高危经皮冠状动脉介入治疗（PCI）期间。虽然IABP支持可改善心源性休克患者的微循环，但在血流动力学稳定的患者中其效果仍不明确。因此，我们试图评估IABP治疗对接受择期高危PCI的血流动力学稳定患者微循环的影响。
对6例左主干狭窄>50%的患者，根据现行指南，使用侧流暗视野显微镜评估微循环，无需使用荧光染料即可观察微循环血管。由一名经过培训的研究人员使用半定量系统（0=无血流；1=间歇性血流；2=缓慢血流；3=连续血流）对每个血管类别（直径：10 - 25微米和26 - 50微米）的微循环进行单独分析。获取稳态记录以及选择性植入的IABP停止后二十秒的额外记录。
在这组血流动力学稳定的患者中，使用IABP时，直径10 - 25微米和26 - 50微米血管类别的微循环增加。停止IABP后，微循环从2.73±0.39（p = 0.052；26 - 50微米：2.88±0.20，p = 0.008）降至2.22±0.23（2.18±0.45），重新启动IABP后增加至2.90±0.14（p = 0.009；2.85±0.28，p = 0.009）。
IABP循环支持可增加舌下黏膜最小血管的微循环血流。我们的数据支持这一假设，即主动脉内球囊反搏可增加冠状动脉和微血管灌注，从而即使在血流动力学稳定的患者中也能改善微循环。IABP的使用可能会提高复杂PCI的安全性并降低有害并发症的风险。
