体外反搏对心脏手术后心脏做功的影响：负责临床获益机制的启示。

Effect of external counterpulsation on cardiac work following cardiac surgery: implications of the mechanism responsible for clinical benefits.

机构信息

Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba 300-2622, Ibaraki, Japan.

出版信息

J Cardiol. 2012 Jan;59(1):84-90. doi: 10.1016/j.jjcc.2011.08.005. Epub 2011 Oct 22.

DOI:10.1016/j.jjcc.2011.08.005

PMID:22018874

Abstract

BACKGROUND

External counterpulsation (ECP) has been recognized as a non-invasive treatment for chronic refractory angina or heart failure. However, the mechanisms responsible for the clinical benefits of ECP therapy remain elusive. Moreover, the clinical significance of ECP therapy for postoperative patients has not been established yet.

METHODS

Six adult patients received ECP therapy for 60 min under pulmonary artery catheter monitoring after cardiac surgery. Hemodynamic data were obtained before ECP therapy (pre-ECP), 20 min after ECP was commenced (20-min-ECP), 40 min after ECP was commenced (40-min-ECP), and after ECP therapy (post-ECP).

RESULTS

The mean right atrial pressure (pre-ECP: 9 ± 4 mmHg; 20-min-ECP: 12 ± 5 mmHg; 40-min-ECP: 12 ± 4 mmHg; and post-ECP: 9 ± 4 mmHg), pulmonary wedge pressure (16 ± 6 mmHg, 20 ± 7 mmHg, 20 ± 7 mmHg, and 17 ± 7 mmHg, respectively), cardiac index (2.4 ± 0.4 l/min/m(2), 2.8 ± 0.6 l/min/m(2), 2.7 ± 0.5 l/min/m(2), and 2.5 ± 0.4 l/min/m(2), respectively), cardiac work index (2.5 ± 0.4 kgm/m(2), 3.3 ± 0.8 kgm/m(2), 3.1 ± 0.8 kgm/m(2), and 2.6 ± 0.5 kgm/m(2), respectively), and left ventricular stroke work index (32 ± 7 gm/m(2), 41 ± 12 gm/m(2), 39 ± 12 gm/m(2), and 33 ± 8 gm/m(2), respectively) significantly (p<0.05) increased after ECP was commenced (pre-ECP vs. 20-min-ECP) and decreased after ECP was discontinued (40-min-ECP vs. post-ECP). Significant (p<0.001) diastolic augmentation (20-min-ECP: 24 ± 6%, 40-min-ECP: 23 ± 5%) and systolic unloading (3 ± 1%, and 3 ± 1%, respectively) were obtained. No clinical adverse effects were observed.

CONCLUSIONS

ECP increases venous return, cardiac output, and cardiac work in addition to diastolic augmentation and systolic unloading. These actions may play important roles in the clinical benefits of ECP therapy. Our data also suggest that ECP is beneficial for patients undergoing cardiac surgery.

摘要

背景

体外反搏（ECP）已被公认为治疗慢性难治性心绞痛或心力衰竭的一种非侵入性治疗方法。然而，ECP 治疗的临床获益的机制仍难以捉摸。此外，ECP 治疗对术后患者的临床意义尚未确定。

方法

6 例成年患者在心脏手术后接受肺动脉导管监测下的 ECP 治疗 60 分钟。在 ECP 治疗前（ECP 前）、ECP 开始后 20 分钟（20 分钟-ECP）、ECP 开始后 40 分钟（40 分钟-ECP）和 ECP 治疗后（ECP 后）获得血流动力学数据。

结果

右心房压（ECP 前：9±4mmHg；20 分钟-ECP：12±5mmHg；40 分钟-ECP：12±4mmHg；ECP 后：9±4mmHg）、肺楔压（16±6mmHg、20±7mmHg、20±7mmHg 和 17±7mmHg）、心指数（2.4±0.4l/min/m2、2.8±0.6l/min/m2、2.7±0.5l/min/m2 和 2.5±0.4l/min/m2）、心脏做功指数（2.5±0.4kgm/m2、3.3±0.8kgm/m2、3.1±0.8kgm/m2 和 2.6±0.5kgm/m2）和左心室每搏功指数（32±7gm/m2、41±12gm/m2、39±12gm/m2 和 33±8gm/m2）在 ECP 开始后（ECP 前与 20 分钟-ECP）显著增加，并在 ECP 停止后（40 分钟-ECP 与 ECP 后）降低（p<0.05）。获得了显著的（p<0.001）舒张期增强（20 分钟-ECP：24±6%，40 分钟-ECP：23±5%）和收缩卸载（3±1%和 3±1%）。未观察到临床不良事件。