外周 ECMO 灌注水平对心血管系统血流动力学的影响。

Hemodynamic effects of perfusion level of peripheral ECMO on cardiovascular system.

机构信息

Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China.

Peking University Health Science Center, Xueyuan Rd, Haidian District, Beijing, 100083, China.

出版信息

Biomed Eng Online. 2018 May 9;17(1):59. doi: 10.1186/s12938-018-0493-5.

DOI:10.1186/s12938-018-0493-5

PMID:29743080

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5944029/

Abstract

BACKGROUND

Peripheral ECMO is an effective cardiopulmonary support in clinical. The perfusion level could directly influence the performances and complications. However, there are few studies on the effects of the perfusion level on hemodynamics of peripheral ECMO.

METHODS

The geometric model of cardiovascular system with peripheral ECMO was established. The blood assist index was used to classify the perfusion level of the ECMO. The flow pattern from the aorta to the femoral artery and their branches, blood flow rate from aorta to brain and limbs, flow interface, harmonic index of blood flow, wall shear stress and oscillatory shear index were chosen to evaluate the hemodynamic effects of peripheral ECMO.

RESULTS

The results demonstrated that the flow rate of aorta outlets increased and perfusion condition had been improved. And the average flow to the upper limbs and brain has a positive correlation with BAI (r = 0.037, p < 0.05), while there is a negative correlation with lower limbs (r = - 0.054, p < 0.05). The HI has negative correlation with BAI (p < 0.05, r < 0). The blood interface is further from the heart with the BAI decrease. And the average WSS has negative correlation with BAI (p < 0.05, r = - 0.983) at the bifurcation of femoral aorta and has positive correlation with BAI (p < 0.05, r = 0.99) at the inner aorta. The OSI under different BAI is higher (reaching 0.4) at the inner wall of the aortic arch, the descending aorta and the femoral access.

CONCLUSIONS

The pathogenesis of peripheral ECMO with different perfusion levels varies; its further research will be thorough and extensive.

摘要

背景

体外膜肺氧合（ECMO）是一种有效的心肺支持治疗手段，灌注水平直接影响 ECMO 的性能和并发症。然而，关于灌注水平对体外膜肺氧合血液动力学影响的研究较少。

方法

建立体外膜肺氧合心血管系统的几何模型，采用体外膜肺氧合血液辅助指数（BAI）对灌注水平进行分类，选择从主动脉到股动脉及其分支的血流模式、从主动脉到脑和四肢的血流速率、血流界面、血流谐波指数（HI）、壁面切应力（WSS）和振荡切应力指数（OSI）来评价体外膜肺氧合的血液动力学效应。

结果

结果表明，主动脉出口流量增加，灌注状况得到改善；上肢和脑的平均血流量与 BAI 呈正相关（r=0.037，p<0.05），与下肢呈负相关（r=-0.054，p<0.05）；HI 与 BAI 呈负相关（p<0.05，r<0）。随着 BAI 的降低，血液界面进一步远离心脏。平均 WSS 与 BAI 呈负相关（p<0.05，r=-0.983），在股总动脉分叉处；与 BAI 呈正相关（p<0.05，r=0.99），在主动脉内。不同 BAI 下 OSI 在主动脉弓、降主动脉和股动脉入口的内表面较高（达到 0.4）。