Lefemine A A, Dunbar J
VA Central Office, Washington, DC 20420.
J Biomater Appl. 1990 Apr;4(4):333-61. doi: 10.1177/088532829000400401.
The application of pumps and other mechanical and physiologic aids for improving circulation and heart recovery must be based on physiologic requirements. The needs of circulation and cardiac recovery are different and depend on competence of the right ventricle as well as the left ventricle and the pattern of cannulation and decompression. Our studies of various bypass techniques and drugs in a standardized severe cardiogenic shock model lead us to believe that biventricular decompression can be accomplished with a single centrifugal pump without an oxygenator. Cardiogenic shock and severe biventricular failure was best treated by LV + RA bypass, based on survival, hemodynamics and metabolism. LA + RA bypass was the next best. LA bypass, LV bypass, substrates (cysteine and ribose) and nitroprusside were intermediate. Circulatory support is not enough unless appropriate cardiac decompression ensures myocardial recovery.
用于改善循环和心脏恢复的泵及其他机械和生理辅助设备的应用必须基于生理需求。循环和心脏恢复的需求各不相同，取决于右心室以及左心室的功能，以及插管和减压方式。我们在标准化的严重心源性休克模型中对各种旁路技术和药物进行的研究使我们相信，使用单个无氧合器的离心泵即可实现双心室减压。基于生存率、血流动力学和代谢情况，左心室+右心房旁路是治疗心源性休克和严重双心室衰竭的最佳方法。左心房+右心房旁路次之。左心房旁路、左心室旁路、底物（半胱氨酸和核糖）和硝普钠的效果居中。除非适当的心脏减压能确保心肌恢复，否则循环支持是不够的。
