Du Zhongtao, Jia Zaishen, Wang Jinhong, Xing Zhichen, Jiang Chunjing, Xu Bo, Yang Xiaofang, Yang Feng, Miao Na, Xing Jialin, Wang Hong, Jia Ming, Hou Xiaotong
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, P.R. China.
Clin Hemorheol Microcirc. 2018;70(1):27-37. doi: 10.3233/CH-16156.
Little is known about the effect of mean arterial blood pressure (MAP) augmentation on the microcirculation in cardiogenic-shock patients with peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support. We investigated the effect of increasing MAP on the microcirculation in cardiogenic-shock patients with ECMO support.
A single-center prospective observational study under taken in ICU patients undergoing ECMO support for post-cardiotomy cardiogenic shock was carried out. Patients with MAP <60 mmHg treated with ECMO support were the study cohort. Inotropic and vasopressor agents (dopamine, dobutamine, norepinephrine or epinephrine) were administered to maintain the MAP at 60-90 mmHg. Hemodynamic and microcirculatory data were obtained at a baseline MAP of <60 mmHg and 1 h after target MAP was reached. As parameters of microcirculation, we measured thenar eminence tissue oxygenation (StO2) and its change during the vessel obstruction test and cerebral tissue oxygenation (rSO2) with near-infrared spectroscopy.
Seventeen patients were enrolled in the study. MAP of all patients increased and reached predefined therapeutic targets (52 [50-54.5] vs.74 [70-78.5] mmHg; p < 0.001). To obtain these targets, doses of inotropic agents were increased (inotrope score increased from 14 [15.5-28] μg/kg/min; p < 0.001). No obvious changes were observed in thenarmuscleStO2 and cerebral rSO2. Thenar muscle StO2 desaturation slope and resaturation slopes during the vessel obstruction test were also unchanged.
Increasing MAP from <60 mmHg to 60-90 mmHg did not affect microcirculation variables in cardiogenic-shock patients with ECMO support.
对于外周静脉 - 动脉体外膜肺氧合（ECMO）支持的心源休克患者，平均动脉血压（MAP）升高对微循环的影响知之甚少。我们研究了提高MAP对接受ECMO支持的心源休克患者微循环的影响。
对在ICU接受ECMO支持的心内直视术后心源休克患者进行了一项单中心前瞻性观察研究。接受ECMO支持且MAP<60 mmHg的患者为研究队列。使用血管活性药物（多巴胺、多巴酚丁胺、去甲肾上腺素或肾上腺素）将MAP维持在60 - 90 mmHg。在MAP<60 mmHg的基线水平以及达到目标MAP后1小时获取血流动力学和微循环数据。作为微循环参数，我们使用近红外光谱法测量了鱼际肌组织氧合（StO2）及其在血管阻塞试验期间的变化以及脑组织氧合（rSO2）。
17名患者纳入研究。所有患者的MAP均升高并达到预定治疗目标（52[50 - 54.5] vs.74[70 - 78.5] mmHg；p<0.001）。为达到这些目标，血管活性药物剂量增加（血管活性评分从14[15.5 - 28]μg/kg/min增加；p<0.001）。鱼际肌StO2和脑rSO2未观察到明显变化。血管阻塞试验期间鱼际肌StO2去饱和斜率和再饱和斜率也未改变。
将MAP从<60 mmHg提高到60 - 90 mmHg对接受ECMO支持的心源休克患者的微循环变量没有影响。
