Bowald S, Eriksson I, Wiklund L
Acta Chir Scand. 1980;146(5):343-9.
The aorta and common iliac arteries were clamped for 2 hours in 27 pigs under general anaesthesia. Ten pigs were heparinized and the other 17 did not receive heparin. A further 5 pigs were used as sham-operated non-heparinized controls. Blood gases and also mean arterial, pulmonary arterial, pulmonary capillary wedge and left atrial pressures were recorded before, during, and after clamping. In the non-heparinized pigs there was a significant increase in pulmonary capillary wedge pressure during and after clamping of the aorta, slight variations in the left atrial pressure (measured in 5 non-heparinized pigs) and a decrease in PaO2, which was especially pronounced after declamping of the aorta. No such changes occurred in heparinized or control animals. The discrepant results in heparinized and non-heparinized animals indicate a mechanism influenced by heparin. Clamping and declamping of the aorta obviously accelerated the changes in the non-heparinized animals. It is suggested that these changes are caused by pulmonary embolism induced by the clamping and declamping of the aorta. Alterations in the pulmonary circulation indicated that the mean pulmonary capillary wedge pressure is not a reliable indicator of left ventricular filling pressure during aortic surgery.
在全身麻醉下,对27头猪的主动脉和髂总动脉进行了2小时的钳夹。10头猪肝素化,另外17头未接受肝素治疗。另有5头猪作为未肝素化的假手术对照。在钳夹前、钳夹期间和钳夹后记录血气以及平均动脉压、肺动脉压、肺毛细血管楔压和左心房压。在未肝素化的猪中,主动脉钳夹期间和钳夹后肺毛细血管楔压显著升高,左心房压有轻微变化(在5头未肝素化的猪中测量),动脉血氧分压降低,在主动脉松钳后尤为明显。肝素化动物或对照动物未出现此类变化。肝素化和未肝素化动物的不同结果表明存在一种受肝素影响的机制。主动脉的钳夹和松钳明显加速了未肝素化动物的变化。提示这些变化是由主动脉的钳夹和松钳诱发的肺栓塞引起的。肺循环的改变表明,在主动脉手术期间,平均肺毛细血管楔压不是左心室充盈压的可靠指标。