Schampaert Stéphanie, van Nunen Lokien X, Pijls Nico H J, Rutten Marcel C M, van Tuijl Sjoerd, van de Vosse Frans N, van 't Veer Marcel
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Artif Organs. 2015 Nov;39(11):931-8. doi: 10.1111/aor.12470. Epub 2015 May 1.
The blood pressure changes induced by the intra-aortic balloon pump (IABP) are expected to create clinical improvement in terms of coronary perfusion and myocardial oxygen consumption. However, the measured effects reported in literature are inconsistent. The aim of this study was to investigate the influence of ischemia on IABP efficacy in healthy hearts and in shock. Twelve slaughterhouse porcine hearts (hearts 1-12) were connected to an external circulatory system, while physiologic cardiac performance was restored. Different clinical scenarios, ranging from healthy to cardiogenic shock, were simulated by step-wise administration of negative inotropic drugs. In hearts 7-12, severe global myocardial ischemia superimposed upon the decreased contractile states was created. IABP support was applied in all hearts under all conditions. Without ischemia, the IABP induced a mild increase in coronary blood flow and cardiac output. These effects were strongly augmented in the presence of persisting ischemia, where coronary blood flow increased by 49 ± 24% (P < 0.01) and cardiac output by 17 ± 6% (P < 0.01) in case of severe pump failure. As expected, myocardial oxygen consumption increased in case of ischemia (21 ± 17%; P < 0.01), while it slightly decreased without (-3 ± 6%; P < 0.01). In case of progressive pump failure due to persistent myocardial ischemia, the IABP increased hyperemic coronary blood flow and cardiac output significantly, and reversed the progressive hemodynamic deterioration within minutes. This suggests that IABP therapy in acute myocardial infarction is most effective in patients with viable myocardium, suffering from persistent myocardial ischemia, despite adequate epicardial reperfusion.
主动脉内球囊反搏（IABP）引起的血压变化有望在冠状动脉灌注和心肌氧消耗方面带来临床改善。然而，文献报道的测量结果并不一致。本研究的目的是探讨缺血对健康心脏和休克状态下IABP疗效的影响。将12个屠宰场猪心脏（心脏1 - 12）连接到外部循环系统，同时恢复生理心脏功能。通过逐步给予负性肌力药物模拟从健康到心源性休克的不同临床情况。在心脏7 - 12中，在收缩状态降低的基础上造成严重的全心心肌缺血。在所有情况下对所有心脏均应用IABP支持。在无缺血情况下，IABP使冠状动脉血流量和心输出量轻度增加。在持续缺血的情况下，这些效应显著增强，在严重泵衰竭时冠状动脉血流量增加49±24%（P < 0.01），心输出量增加17±6%（P < 0.01）。正如预期的那样，缺血时心肌氧消耗增加（21±17%；P < 0.01），而无缺血时则略有下降（-3±6%；P < 0.01）。在由于持续性心肌缺血导致的进行性泵衰竭情况下，IABP显著增加充血性冠状动脉血流量和心输出量，并在数分钟内逆转进行性血流动力学恶化。这表明，尽管有足够的心外膜再灌注，但IABP治疗对患有持续性心肌缺血的存活心肌患者的急性心肌梗死最为有效。
