Oba J
Second Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Hokkaido Igaku Zasshi. 1993 Jul;68(4):530-6.
Direct effects of percutaneous cardiopulmonary support (PCPS) on cardiac function were evaluated. Also, the efficacy of left ventricular venting to unload the heart was assessed. Eleven open-chested dogs were placed on PCPS with the flow equal to the baseline cardiac output for 30 minutes. Six out of eleven had left ventricle vented (VENT) by means of venting tube which was indwelt in the left ventricular cavity, while other five did not (NONVENT). Hemodynamic indices were obtained before and on PCPS. Measured, derived or calculated variables included heart rate (HR), mean aortic pressure (mean AOP), left ventricular end-diastolic pressure (LVEDP), peak left ventricular pressure (peak LVP), peak LVdp/dt, rate-pressure product (RPP, HR x peak LVP) and aortic-coronary sinus oxygen content difference (ACsO2D). There was no difference in any variables between the groups at baseline. On PCPS, in the VENT group, HR increased 27% from baseline (p < 0.05), while mean AOP did not change. All other variables showed significant (p < 0.05) reduction in VENT. Percent change from baseline value in VENT was: -24% for LVEDP, -47% for peak LVP, -41% for peak LVdp/dt, -32% for RPP and -42% for ACsO2D. No variable differed significantly from baseline in the NONVENT group on PCPS. The author concluded that left ventricular venting favorably alters the loading and contractile profile of the heart on PCPS without affecting systemic circulation.
评估了经皮心肺支持(PCPS)对心脏功能的直接影响。此外,还评估了左心室排气以减轻心脏负荷的效果。11只开胸犬接受PCPS治疗,流量等于基线心输出量,持续30分钟。11只中有6只通过置于左心室腔的排气管使左心室排气(VENT组),而另外5只未排气(NONVENT组)。在PCPS治疗前及治疗过程中获取血流动力学指标。测量、推导或计算的变量包括心率(HR)、平均主动脉压(平均AOP)、左心室舒张末期压力(LVEDP)、左心室峰值压力(峰值LVP)、峰值LVdp/dt、速率-压力乘积(RPP,HR×峰值LVP)以及主动脉-冠状窦氧含量差(ACsO2D)。两组在基线时任何变量均无差异。在PCPS治疗时,VENT组中,HR较基线升高27%(p<0.05),而平均AOP未改变。VENT组中所有其他变量均显著降低(p<0.05)。VENT组较基线值的变化百分比为:LVEDP为-24%,峰值LVP为-47%,峰值LVdp/dt为-41%,RPP为-32%,ACsO2D为-42%。PCPS治疗时NONVENT组中无变量与基线有显著差异。作者得出结论,左心室排气可在不影响体循环的情况下,有利地改变PCPS时心脏的负荷和收缩状态。