Saggau W, Bacá I, Ros E, Storch H H, Schmitz W
Herz. 1980 Feb;5(1):42-50.
In 20 patients who underwent open-heart surgery, the plasma concentrations of glucose, insulin, glucagon, growth hormone, free hemoglobin, and cholinesterase were measured before, during and after pulsatile and continuous perfusion. Pulsatile flow was achieved by modification of a roller pump to effect rapid acceleration and slowing. The driving motor was interfaced with a control module to enable ECG-triggered perfusion. In addition to the clinical studies, investigations were performed in 9 dogs to assess the effects of pulsatile and continuous perfusion on liver and pancreas flow during total bypass. During pulsatile perfusion there was a significant increase in insulin which, however, was clearly diminished in relation to glucose levels. The response of the beta-cells was markedly more compromised after continuous than pulsatile perfusion. The secondary postoperative increase in insulin can be accounted for by intravenous administration of glucose and, particularly, after pulsatile perfusion, indicates an almost completely normal response of pancreatic beta-cells. As opposed to the effects of continuous perfusion, the low glucose, glucagon, and growth hormone levels, the insulin increase during and after pulsatile perfusion as well as normal cholinesterase values observed in association with pulsatile perfusion appear to be the result of improved pancreatic and hepatic function. This contention is supported by the experimental finding of significantly increased pancreas and liver perfusion during pulsatile perfusion.
在20例接受心脏直视手术的患者中，分别于搏动灌注和持续灌注前、灌注期间及灌注后测量了血浆葡萄糖、胰岛素、胰高血糖素、生长激素、游离血红蛋白和胆碱酯酶的浓度。通过对滚压泵进行改良以实现快速加速和减速，从而实现搏动血流。驱动电机与控制模块相连，以实现心电图触发的灌注。除了临床研究外，还对9只犬进行了研究，以评估在完全体外循环期间搏动灌注和持续灌注对肝脏和胰腺血流的影响。在搏动灌注期间，胰岛素显著增加，然而，相对于血糖水平明显降低。与搏动灌注相比，持续灌注后β细胞的反应明显更受损害。术后胰岛素的继发性增加可通过静脉输注葡萄糖来解释，特别是在搏动灌注后，这表明胰腺β细胞的反应几乎完全正常。与持续灌注的影响相反，搏动灌注期间和之后出现的低血糖、胰高血糖素和生长激素水平、胰岛素增加以及正常的胆碱酯酶值似乎是胰腺和肝功能改善的结果。搏动灌注期间胰腺和肝脏灌注显著增加这一实验结果支持了这一论点。
