主动脉内球囊反搏对接受静脉-动脉体外膜肺氧合支持的心源性休克患者大循环和微循环的影响*

Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation*.

作者信息

Petroni Thibaut, Harrois Anatole, Amour Julien, Lebreton Guillaume, Brechot Nicolas, Tanaka Sébastien, Luyt Charles-Edouard, Trouillet Jean-Louis, Chastre Jean, Leprince Pascal, Duranteau Jacques, Combes Alain

机构信息

1Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. 2Department of Anesthesiology and Critical Care Medicine, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Le Kremlin-Bicêtre, France. 3Department of Anesthesiology and Critical Care Medicine, UMRS INSERM 956, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. 4Department of Cardiac Surgery, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.

出版信息

Crit Care Med. 2014 Sep;42(9):2075-82. doi: 10.1097/CCM.0000000000000410.

DOI:10.1097/CCM.0000000000000410

PMID:24810530

Abstract

OBJECTIVES

This study was designed to assess the effects on macrocirculation and microcirculation of adding an intra-aortic balloon pump to peripheral venoarterial extracorporeal membrane oxygenation in patients with severe cardiogenic shock and little/no residual left ventricular ejection.

DESIGN

A prospective, single-center, observational study where macrocirculation and microcirculation were assessed with clinical-, Doppler echocardiography-, and pulmonary artery-derived hemodynamic variables and also cerebral and thenar eminence tissue oxygenation and side-stream dark-field imaging of sublingual microcirculation.

SETTING

A 26-bed tertiary ICU in a university hospital.

PATIENTS

We evaluated 12 consecutive patients before and 30 minutes after interrupting and restarting intra-aortic balloon pump.

INTERVENTIONS

Measurements were performed before, and 30 minutes after interrupting and restarting intra-aortic balloon pump.

MEASUREMENTS AND MAIN RESULTS

Stopping intra-aortic balloon pump was associated with higher pulmonary artery-occlusion pressure (19 ± 10 vs 15 ± 8 mm Hg, p = 0.01), increased left ventricular end-systolic (51 ± 13 vs 50 ± 14 mm, p = 0.05) and end-diastolic (55 ± 13 vs 52 ± 14 mm, p = 0.003) dimensions, and decreased pulse pressure (15 ± 13 vs 29 ± 22 mm Hg, p = 0.02). Maximum pulmonary artery-occlusion pressure reduction when the intra-aortic balloon pump was restarted was observed in the seven patients whose pulmonary artery-occlusion pressure was more than 15 mm Hg when intra-aortic balloon pump was off (-6.6 ± 4.3 vs -0.6 ± 3.4 mm Hg, respectively). Thenar eminence and brain tissue oxygenation and side-stream dark-field-assessed sublingual microcirculation were unchanged by stopping and restarting intra-aortic balloon pump.

CONCLUSIONS

Restoring pulsatility and decreasing left ventricular afterload with intra-aortic balloon pump was associated with smaller left ventricular dimensions and lower pulmonary artery pressures but did not affect microcirculation variables in cardiogenic shock patients with little/no residual left ventricular ejection while on peripheral venoarterial extracorporeal membrane oxygenation.

摘要

目的

本研究旨在评估在严重心源性休克且左心室射血所剩无几或无射血的患者中，在周围静脉-动脉体外膜肺氧合基础上加用主动脉内球囊泵对大循环和微循环的影响。

设计

一项前瞻性、单中心观察性研究，通过临床、多普勒超声心动图和肺动脉衍生的血流动力学变量评估大循环和微循环，同时评估脑和鱼际组织氧合以及舌下微循环的旁流暗视野成像。

场所

一所大学医院的拥有26张床位的三级重症监护病房。

患者

我们评估了12例连续患者在中断和重新启动主动脉内球囊泵之前以及之后30分钟的情况。

干预措施

在中断和重新启动主动脉内球囊泵之前以及之后30分钟进行测量。

测量指标及主要结果

停止主动脉内球囊泵与肺动脉闭塞压升高相关（19±10 vs 15±8 mmHg，p = 0.01），左心室收缩末期内径（51±13 vs 50±14 mm，p = 0.05）和舒张末期内径增加（55±13 vs 52±14 mm，p = 0.003），脉压降低（15±13 vs 29±22 mmHg，p = 0.02）。在主动脉内球囊泵关闭时肺动脉闭塞压超过15 mmHg的7例患者中，观察到重新启动主动脉内球囊泵时肺动脉闭塞压的最大降低幅度（分别为-6.6±4.3 vs -0.6±3.4 mmHg）。停止和重新启动主动脉内球囊泵对鱼际组织和脑组织氧合以及旁流暗视野评估的舌下微循环无影响。