Iscan Sahin, Cakir Habib, Eygi Bortecin, Yurekli Ismail, Donmez Koksal, Ayvat Pınar Unde, Pekel Derya Sarıkaya, Kestelli Mert
1 Katip Celebi University Izmir Ataturk Training and Research Hospital, Department of Cardiovascular Surgery, Izmir, Turkey.
2 Katip Celebi University Izmir Ataturk Training and Research Hospital, Department of Anesthesiology, Izmir, Turkey.
Perfusion. 2017 Oct;32(7):561-567. doi: 10.1177/0267659117706606. Epub 2017 May 18.
The aim of this study was to assess the relationships among cardiac output, extracorporeal blood flow, cannulation site, right (RCa) and left carotid (LCa), celiac (Ca) and renal artery (Ra) flows during extracorporeal circulation.
A mock circulatory circuit was assembled, based on a compliant anatomical aortic model. The ascending aorta, right subclavian and femoral artery cannulations were created and flow was provided by a centrifugal pump (Cp); cardiac output was provided by a roller pump (Rp). Five volume flow rates were tested. The Rp was set at 4 L/min with no Cp flow (R-C) and the basic volume flow rates of the vessels were measured. The flow of the Cp was increased while the Rp flow was decreased for other measurements; R-C, R-C, R-C and R-C. Measurements were repeated for all cannulation sites.
The RCa flow rate at R-C was higher compared to the R-C, R-C, R-C and R-C RCa flows with subclavian cannulation. The RCa flow decreased as the Cp flow increased (p<0.05). The RCa flow with ascending aortic and femoral cannulation was higher compared to subclavian cannulation. Higher flows were obtained with subclavian cannulation in the LCa compared to the others (p<0.05). R-C Ca and Ra flows were higher compared to other Ca and Ra flows with femoral cannulation. Ca and Ra flows decreased as Cp flow increased. Flows of the Ca and Ra with ascending and subclavian cannulations were not lower compared to the R-C flow (p<0.05).
This study shows that prolonged extracorporeal circulation may develop flow decrease and ischemia in cerebral and abdominal organs with both subclavian and femoral cannulations.
本研究的目的是评估体外循环期间心输出量、体外血流量、插管部位（右颈动脉[RCa]和左颈动脉[LCa]、腹腔干[Ca]和肾动脉[Ra]）血流之间的关系。
基于顺应性解剖主动脉模型组装了一个模拟循环回路。建立升主动脉、右锁骨下动脉和股动脉插管，并由离心泵（Cp）提供血流；心输出量由滚压泵（Rp）提供。测试了五种体积流量。将Rp设置为4 L/min且无Cp血流（R-C），并测量血管的基础体积流量。在其他测量中，增加Cp的血流同时减少Rp的血流；R-C、R-C、R-C和R-C。对所有插管部位重复进行测量。
与锁骨下动脉插管时的R-C、R-C、R-C和R-C时的RCa血流相比，R-C时的RCa血流速率更高。随着Cp血流增加，RCa血流减少（p<0.05）。与锁骨下动脉插管相比，升主动脉和股动脉插管时的RCa血流更高。与其他情况相比，锁骨下动脉插管时LCa的血流更高（p<0.05）。与股动脉插管时的其他Ca和Ra血流相比，R-C时Ca和Ra血流更高。Ca和Ra血流随着Cp血流增加而减少。升主动脉和锁骨下动脉插管时Ca和Ra的血流与R-C血流相比并不更低（p<0.05）。
本研究表明，延长的体外循环可能导致锁骨下动脉和股动脉插管时脑和腹部器官血流减少和缺血。
