Orime Y, Shiono M, Nakata K, Hata M, Sezai A, Yamada H, Iida M, Kashiwazaki S, Nemoto M, Kinoshita J, Kojima T, Saito T, Sezai Y
Second Department of Surgery, Nihon University School of Medicine Tokyo, Japan.
ASAIO J. 1996 Sep-Oct;42(5):M724-9. doi: 10.1097/00002480-199609000-00083.
To estimate the effectiveness of pulsatility in end-organ microcirculation after cardiogenic shock, experimental studies using swine were done. Cardiogenic shock was produced in 14 pigs by ligating the left anterior descending branches so that mean aortic pressure dropped to 60% of the control value. After inducing shock, left atrial to ascending Ao bypass was initiated. A pneumatic pulsatile pump (Zeon Medical Inc, Tokyo, Japan) was used in seven pigs (Group P) and a centrifugal pump (BP-80, BioMedicus Inc, Minneapolis, MN) in seven (Group NP). In both groups, about half the usual cardiac output was supported for 3 hr, maintaining mean aortic pressure at approximately 100 mm Hg. The pulse pressure was 36.6 +/- 4.6 mm Hg in Group P, and 14.3 +/- 1.5 mm Hg in Group NP. Epicardial and endocardial regional flows recovered after assist in both groups. There were no significant differences between the two groups. However, liver tissue flow, renal cortex flow, and stomach mucous flow in Group P was significantly higher than those of Group NP after support (p < 0.05). In addition, arterial blood ketone ratio in Group P was 0.61 +/- 0.13 vs 0.39 +/- 0.06 in Group NP, a significant difference (p < 0.05). These results suggest that in uneven blood flow distribution of end organs after cardiogenic shock, pulsatility was effective in improving and maintaining function and microcirculation of end organs, preventing multiorgan failure.
为评估心源性休克后终末器官微循环中搏动性的有效性，开展了使用猪的实验研究。通过结扎左前降支使14头猪产生心源性休克，以使平均主动脉压降至对照值的60%。诱导休克后，开始进行左心房至升主动脉旁路术。7头猪使用气动搏动泵（日本东京Zeon Medical公司）（P组），7头猪使用离心泵（美国明尼阿波利斯BioMedicus公司的BP - 80）（NP组）。两组均以约一半的正常心输出量维持3小时，将平均主动脉压维持在约100 mmHg。P组的脉压为36.6±4.6 mmHg，NP组为14.3±1.5 mmHg。两组在辅助后心外膜和心内膜局部血流均恢复。两组间无显著差异。然而，支持后P组的肝组织血流、肾皮质血流和胃黏膜血流显著高于NP组（p<0.05）。此外，P组的动脉血酮比为0.61±0.13，而NP组为0.39±0.06，差异显著（p<0.05）。这些结果表明，在心源性休克后终末器官血流分布不均的情况下，搏动性有助于改善和维持终末器官的功能及微循环，预防多器官功能衰竭。
