Zhu Gang-jie, Sun Li-na, Li Xing-hai, Wang Ning-fu, Wu Hong-hai, Yuan Chen-xing, Li Qiao-qiao, Xu Peng, Ren Ya-qi, Mao Bao-gen
Department of Cardiovasology, Affiliated Hangzhou Hospital of Nanjing Medical University, No.261, Huansha Road, 310006, Hangzhou City, China.
Department of Cardiac Surgery, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou City, China.
Heart Vessels. 2015 Sep;30(5):669-74. doi: 10.1007/s00380-014-0564-x. Epub 2014 Sep 27.
The aim of this study was to explore myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. 24 male pigs (34.6 ± 1.3 kg) were randomly divided into three groups-control group, drug therapy group, and ECMO group. Myocardial infarction model was created in drug therapy group and ECMO group by ligating coronary artery. When cardiogenic shock occurred, drugs were given in drug therapy group and ECMO began to work in ECMO group. The pigs were killed 24 h after cardiogenic shock. Compared with in drug therapy group, left ventricular end-diastolic pressure in ECMO group decreased significantly 6 h after ligation (P < 0.05). At the end of the experiments, LV - dp/dt among three groups was significantly different, drug therapy group < ECMO group < control group. There was no difference in LV + dp/dt between drug therapy group and ECMO group. Compared with drug group, myocardial infarct size of ECMO group did not reduce significantly, but myocardial enzyme and troponin-I decreased significantly. Compared with drug therapy, ECMO improves left ventricular diastolic function, and may improve systolic function. ECMO cannot reduce myocardial infarct size without revascularization, but may have positive effects on ischemic areas by avoiding further injuring.
本研究旨在探讨早期体外膜肺氧合(ECMO)支持对猪急性心肌梗死合并心源性休克的心肌保护作用。将24只雄性猪(34.6±1.3千克)随机分为三组——对照组、药物治疗组和ECMO组。药物治疗组和ECMO组通过结扎冠状动脉建立心肌梗死模型。当发生心源性休克时,药物治疗组给予药物,ECMO组开始进行ECMO支持。心源性休克发生24小时后处死猪。与药物治疗组相比,ECMO组在结扎后6小时左心室舒张末期压力显著降低(P<0.05)。实验结束时,三组之间左心室压力变化最大速率(LV - dp/dt)差异显著,药物治疗组<ECMO组<对照组。药物治疗组和ECMO组之间左心室压力变化最大速率(LV + dp/dt)无差异。与药物组相比,ECMO组心肌梗死面积未显著减小,但心肌酶和肌钙蛋白I显著降低。与药物治疗相比,ECMO可改善左心室舒张功能,并可能改善收缩功能。在没有血运重建的情况下,ECMO不能减小心肌梗死面积,但通过避免进一步损伤,可能对缺血区域产生积极影响。