Gelsomino Sandro, Lozekoot Pieter W J, Lorusso Roberto, de Jong Monique J, Parise Orlando, Matteucci Francesco, Lucà Fabiana, Kumar Narendra, Romano Mario, Gensini Gian Franco, La Meir Mark, Maessen Jos G
Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Ann Thorac Surg. 2016 Apr;101(4):1485-93. doi: 10.1016/j.athoracsur.2015.10.010. Epub 2015 Dec 17.
Changes in hemodynamics, coronary circulation, visceral flow, and biochemical marker rate reduction or volume deflation for intraaortic balloon pump discontinuation were assessed.
Twelve healthy pigs were randomly assigned to two groups, the rate-based (RB, n = 6) and volume-based weaning groups (VB, n = 6). Hemodynamics and visceral and coronary flows were measured at baseline after 2 hours of intraaortic balloon pump 1:1, during the first 5 hours of weaning (frequency rate reduced to 1:2 in the RB group and volume decreased by 10%/h in the VB group), after 1 hour of frequency rate 1:3 in the RB group or a volume decrease by 75% in the VB group, 2 hours after withdrawal, and 4 hours after withdrawal.
The animals weaned by progressive VB deflation showed a greater degree of vasodilation, better cardiac output and stroke volume, fewer negative values of cardiac cycle efficiency, and higher dP/dTmax compared with those weaned by RB reduction (p < 0.05 for all). The VB group also exhibited increased coronary flow, lower oxygen consumption of the myocardium, and coronary resistance during VB weaning (p < 0.05 for all). The serum lactate level was lower in the VB group at each experimental point (p < 0.05 for all), but visceral flows were scarcely affected by the weaning method.
Volume reduction was the most effective weaning method considering that frequency reduction weaning was responsible for significant negative effects on hemodynamics and coronary circulation.
评估了主动脉内球囊反搏停止时血流动力学、冠状动脉循环、内脏血流以及生化标志物降低率或容量减少情况。
将12只健康猪随机分为两组，即基于频率组（RB，n = 6）和基于容量组（VB，n = 6）。在主动脉内球囊反搏1:1状态下2小时后、撤机前5小时（RB组频率降至1:2，VB组容量每小时减少10%）、RB组频率降至1:3或VB组容量减少75% 1小时后、撤机后2小时以及撤机后4小时测量血流动力学、内脏血流和冠状动脉血流。
与通过降低频率撤机的猪相比，通过逐步减少VB容量撤机的猪表现出更大程度的血管舒张、更好的心输出量和每搏输出量、更少的心动周期效率负值以及更高的dP/dTmax（所有比较p < 0.05）。VB组在撤机过程中还表现出冠状动脉血流增加、心肌氧耗降低以及冠状动脉阻力降低（所有比较p < 0.05）。VB组在每个实验点的血清乳酸水平均较低（所有比较p < 0.05），但撤机方法对内脏血流几乎没有影响。
考虑到降低频率撤机对血流动力学和冠状动脉循环有显著负面影响，减少容量是最有效的撤机方法。
