Clinic of Internal Medicine I, Friedrich-Schiller-University, Erlanger Allee 101, 07747, Jena, Germany,
Clin Res Cardiol. 2015 Aug;104(8):679-87. doi: 10.1007/s00392-015-0833-4. Epub 2015 Feb 27.
This study sought to evaluate the influence of intraaortic balloon pump (IABP) counterpulsation on the microcirculation in patients with cardiogenic shock (CS) complicating acute myocardial infarction.
In patients with shock profound alterations of the microcirculation have been observed and their clinical relevance has been described. Different treatment strategies exist to improve microvascular perfusion in patients with CS; however, the role of IABP treatment is not clearly defined.
A predefined substudy of the randomized Intraaortic Balloon Pump in Cardiogenic Shock II trial (IABP-SHOCK II) investigated the sublingual microcirculation using a sidestream darkfield intravital microscope on days 1, 2 and 4 after the onset of shock. Perfused capillary (<20 µm, PCD) and vessel densities (<100 µm, PVD), total capillary (TCD) and vessel (TVD) densities were determined. In addition, the proportion of perfused vessels was assessed.
Forty-one patients were included in this substudy (n = 24 with IABP support vs. n = 17 without IABP support). No significant differences between treatment with or without IABP regarding PCD, PVD, TCD, TVD and the proportion of perfused vessels were evident on all three timepoints (p = n.s. for all). Microvascular perfusion showed inverse correlation with subsequent serum lactate levels (-0.366; p = 0.02) without being significantly correlated with lactate levels at the timepoint of the microcirculatory investigation. In Kaplan-Meier analysis microcirculatory parameters showed significant discrimination of prediction for time to death (p < 0.05 for all).
In patients with CS, there is no effect of IABP treatment on microvascular perfusion. Parameters of the microcirculation might be helpful to identify high risk patients.
本研究旨在评估主动脉内球囊反搏（IABP）反搏对合并急性心肌梗死的心源性休克（CS）患者微循环的影响。
在休克患者中，已经观察到微循环的深刻改变，并描述了其临床相关性。存在不同的治疗策略来改善 CS 患者的微血管灌注；然而，IABP 治疗的作用尚不清楚。
随机主动脉内球囊泵在心源性休克 II 试验（IABP-SHOCK II）的预先设定的亚研究中，在休克发生后第 1、2 和 4 天使用侧流暗场活体显微镜研究舌下微循环。测定灌注毛细血管（<20µm，PCD）和血管密度（<100µm，PVD）、总毛细血管（TCD）和总血管密度（TVD）。此外，还评估了灌注血管的比例。
本亚研究共纳入 41 例患者（IABP 支持 24 例，无 IABP 支持 17 例）。在所有三个时间点，治疗组和非治疗组之间在 PCD、PVD、TCD、TVD 和灌注血管的比例方面均无显著差异（所有 p = n.s.）。微循环灌注与随后的血清乳酸水平呈负相关（-0.366；p = 0.02），但与微循环研究时的乳酸水平无显著相关性。在 Kaplan-Meier 分析中，微循环参数对死亡时间有显著的预测作用（所有 p < 0.05）。
在 CS 患者中，IABP 治疗对微循环灌注没有影响。微循环参数可能有助于识别高危患者。
