Lundemoen Steinar, Kvalheim Venny Lise, Svendsen Øyvind Sverre, Mongstad Arve, Andersen Knut Sverre, Grong Ketil, Husby Paul
Section for Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway.
Section for Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen, Norway; Department of Clinical Science, Haukeland University Hospital, University of Bergen, Bergen, Norway.
Ann Thorac Surg. 2015 Feb;99(2):619-25. doi: 10.1016/j.athoracsur.2014.08.029. Epub 2014 Dec 10.
Recent studies have focused on the use of fixed-rate intraaortic balloon pumping (IABP) during cardiopulmonary bypass (CPB) to achieve pulsatile flow. Because application of an IABP catheter may represent a functional obstruction within the descending aorta, we explored the effect of IABP-pulsed CPB-perfusion with special attention to perfusion above and below the IABP balloon.
Sixteen animals received an IABP catheter that remained turned off position (NP group, n = 8) or was switched to an automatic mode of 80 beats/min during CPB (PP group, n = 8). Flow-data and pressure-data were obtained above and below the IABP balloon. Tissue perfusion was evaluated by microspheres.
IABP-pulsed CPB-perfusion, as assessed at 30 minutes on CPB, increased proximal mean aortic pressure (p < 0.05) and carotid artery blood flow (p < 0.001), but decreased distal mean aortic pressure (p < 0.001). The decrease of distal mean aortic pressure in the PP group was associated with a 75 % decrease (p < 0.001) of renal tissue perfusion. During nonpulsed perfusion the respective variables remained essentially unchanged compared with pre-CPB levels.
Using IABP as a surrogate to achieve pulsatile perfusion during CPB contributes significantly to lowered aortic pressure in the distal portion of aorta and impaired tissue perfusion of the kidneys. The results are focusing on effects that may contribute to organ dysfunction and acute kidney injury. Consequently, assessment of perfusion pressure distal to the balloon should be addressed whenever IABP is used during CPB.
最近的研究聚焦于在体外循环（CPB）期间使用固定速率主动脉内球囊反搏（IABP）来实现搏动性血流。由于IABP导管的应用可能在降主动脉内形成功能性梗阻，我们探讨了IABP搏动性CPB灌注的效果，并特别关注IABP球囊上方和下方的灌注情况。
16只动物接受了IABP导管，其中8只在CPB期间导管处于关闭状态（NP组），另外8只在CPB期间切换至80次/分钟的自动模式（PP组）。获取IABP球囊上方和下方的血流数据和压力数据。通过微球评估组织灌注情况。
在CPB 30分钟时评估发现，IABP搏动性CPB灌注可增加近端平均主动脉压（p < 0.05）和颈动脉血流（p < 0.001），但会降低远端平均主动脉压（p < 0.001）。PP组远端平均主动脉压的降低与肾组织灌注减少75%相关（p < 0.001）。在非搏动性灌注期间，与CPB前水平相比，各变量基本保持不变。
在CPB期间使用IABP作为实现搏动性灌注的替代方法，会显著导致主动脉远端压力降低以及肾脏组织灌注受损。这些结果聚焦于可能导致器官功能障碍和急性肾损伤的影响因素。因此，在CPB期间使用IABP时，应关注球囊远端的灌注压力评估。
