Nanas S N, Nanas J N, Charitos C E, Gougoulakis A, Makaritsis K, Chatzigeorgiou J, Moussoutzani K, Anastasiou-Nana M I, Moulopoulos S D
Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Vas. Sofias 80 & K. Lourou, Athens 11518, Greece.
World J Surg. 1997 Mar-Apr;21(3):318-2l; discussion 322. doi: 10.1007/s002689900236.
During the last decades a number of left ventricular assist devices has been used especially for patients resistant to pharmacologic treatment and to intraaortic balloon pump (IABP) support for left ventricular failure. A high stroke volume para-aortic counterpulsation device (PACD) has been developed utilizing the principle of the diastolic counterpulsation technique. In this study the hemodynamic effects of the valveless PACD were compared to those of the centrifugal blood pump (CBP) in nine dogs in acute experimental cardiogenic shock. Hemodynamic measurements were obtained at baseline with both devices off, PACD on and CBP off, or PACD off and CBP on. There was no difference in mean aortic pressure between PACD on (60.0 +/- 11.5 mmHg) and CBP on (69.0 +/- 26.8 mmHg). Similarly, there was no difference in left ventricular end-diastolic pressure with the PACD on (11.9 +/- 5.4 mmHg) versus the CBP on (9.9 +/- 5.2 mmHg) or the cardiac index with the PACD on (84 +/- 36 ml/kg/min) versus the CBP on (77 +/- 36 ml/kg/min). However, the left ventricular systolic pressure (55.0 +/- 19.0 with PACD versus 73.0 +/- 26.0 with CBP,p < 0.001), the tension time index (712 +/- 381 versus 1333 +/- 694,p < 0.01), and the double product (5629 +/- 2574 versus 7440 +/- 3294,p < 0.01) were significantly lower during assistance with the PACD than with the CBP. It was concluded that PACD is at least as effective as CBP for restoring hemodynamic status during acute experimental cardiogenic shock. Moreover, the PACD unloads the left ventricle more effectively than CBP, making it suitable for left ventricular mechanical support in cases with reversible myocardial damage.
在过去几十年中，一些左心室辅助装置已被用于治疗对药物治疗和主动脉内球囊反搏（IABP）支持左心室衰竭有抵抗的患者。一种利用舒张期反搏技术原理开发的高搏出量主动脉旁反搏装置（PACD）。在本研究中，将无瓣PACD与离心血泵（CBP）在9只急性实验性心源性休克犬中的血流动力学效应进行了比较。在两种装置均关闭、PACD开启且CBP关闭或PACD关闭且CBP开启的基线状态下进行血流动力学测量。PACD开启时（60.0±11.5 mmHg）和CBP开启时（69.0±26.8 mmHg）的平均主动脉压无差异。同样，PACD开启时（11.9±5.4 mmHg）与CBP开启时（9.9±5.2 mmHg）的左心室舒张末期压力，或PACD开启时（84±36 ml/kg/min）与CBP开启时（77±36 ml/kg/min）的心脏指数均无差异。然而，PACD辅助时的左心室收缩压（55.0±19.0与CBP的73.0±26.0，p<0.001）、张力时间指数（712±381与1333±694，p<0.01）和双乘积（5629±2574与7440±3294，p<0.01）均显著低于CBP辅助时。得出的结论是，在急性实验性心源性休克期间，PACD在恢复血流动力学状态方面至少与CBP一样有效。此外，PACD比CBP更有效地减轻左心室负荷，使其适用于可逆性心肌损伤病例的左心室机械支持。
