摘要
目的比较新型主动脉旁反搏装置(paraaortic counterpulsation device,PACD)与主动脉内球囊反搏(intraaortic balloon pump,IABP)装置对羊重度急性心力衰竭的辅助效果。方法选成年小尾寒羊8只,将自制PACD(每搏量为55 ml)的无瓣人工血管吻合于降主动脉,同时于降主动脉内植入IABP(每搏量为40 ml)进行反搏辅助。结扎冠状动脉分支建立重度急性心力衰竭动物模型,观察PACD和IABP辅助对重度急性心力衰竭辅助后的血流动力学变化;实验结束后观察PACD辅助和羊主要器官的变化。结果成功建立了8只羊心力衰竭模型,心力衰竭后心排血量(CO)、肺毛细血管楔压(PCWP)、平均动脉压(MAP)和左心室舒张期末压(LVEDP)与基础值比较差异均有统计学意义(t=-8.466,34.083,25.767,-5.219,P=0.000)。应用IABP和PACD辅助后,平均动脉舒张压(MADP)较辅助前不明显或明显增高(38.34±7.13 mm Hg vs.38.42±6.81 mm Hg,P=0.418;38.34±7.13 mmHg vs.54.14±10.13 mm Hg,P=0.001),IABP与PACD比较差异有统计学意义(P=0.010);而LVEDP较辅助前无明显降低(7.43±2.54 mm Hg vs.7.32±2.14 mm Hg,P=0.498;7.43±2.54 mm Hg vs.6.53±1.91 mm Hg,P=0.821),IABP与PACD比较差异无统计学意义(P=0.651);冠状窦血流量(CSF)较辅助前不明显或明显增加(86.63±7.71 ml/min vs.87.04±6.53 ml/min,P=0.981;86.63±7.71 ml/min vs.110.52±11.03 ml/min,P=0.000),IABP与PACD比较差异有统计学意义(P=0.000);IABP辅助后,左侧颈动脉流量(LCAF)较辅助前无明显降低(131.07±21.26 ml/min vs.128.36±20.38 ml/min,P=0.689),而PACD辅助后较辅助前增加(131.07±21.26 ml/min vs.151.29±18.37 ml/min,P=0.008),IABP与PACD比较差异有统计学意义(P=0.002)。PACD后血囊、人工血管内及动物心脏、肝、肾、肺等器官未见血栓、栓塞和缺血坏死;病理切片在光学显微镜下观察未见明显异常。结论 IABP对羊重度急性心力衰竭无辅助作用,而PACD辅助明显提高了MADP,增加了冠状窦血流量,改善了脑灌注流量,对
Objective To compare the assisting function between a new paraaortic counterpulsation device（PACD） and the intraaortic balloon pump（IABP） in acute severe heart failure in sheep.Methods Eight healthy adult small fattailed sheep were chosen in our study.The self-made PACD（with a stroke volume of 55 ml） was anastomosed to the descending aorta through a valveless graft,and an intraaortic balloon（with a stroke volume of 40 ml） was placed in the descending aorta for the purpose of counterpulsation assisting.Acute severe heart failure model was established by snaring coronary artery branches.The hemodynamic changes of both devices were recorded during,before and after the counterpulsation assisting.Results Eight heart failure sheep models were successfully set up.Cardiac output（CO）,pulmonary capillary wedge pressure（PCWP）,mean arterial pressure（MAP） and left ventricular end diastolic presssure（LVEDP） after the heart failure were significantly different compared with basic value（t=-8.466,34.083,25.767,-5.219,P=0.000）.After IABP and PACD assisting,the mean aortic diastolic pressure（MADP） didn＇t significantly or did increase（38.34±7.13 mm Hg vs.38.42±6.81 mm Hg,P=0.418;38.34±7.13 mm Hg vs.54.14±10.13 mm Hg,P=0.001）,and the degree of increasing between the two methods showed a significant difference（P=0.010）;LVEDP didn＇t significantly decrease（7.43±2.54 mmHg vs.7.32±2.14 mm Hg,P=0.498;7.43±2.54 mm Hg vs.6.53±1.91 mm Hg,P=0.821）,and there was no significant difference between the two methods in the change（P=0.651）;the coronary sinus flow（CSF） didn＇t significantly or did increase（86.63±7.71 ml/min vs.87.04±6.53 ml/min,P=0.981;86.63±7.71 ml/min vs.110.52±11.03 ml/min,P=0.000）,and there was a significant difference in the change of CSF between the two methods（P=0.000）.IABP didn＇t significantly decrease the left carotid artery flow（LCAF）（131.07±21.26 ml/min vs.128.36± 20.38 ml/min,P=0.689）,while PACD increased it（131.07±21.26 ml/
出处
《中国胸心血管外科临床杂志》
CAS
2011年第2期136-140,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
心室辅助装置
重度心力衰竭
主动脉旁反搏
主动脉内球囊反搏
Ventricular assist devices
Severe heart failure
Paraaortic counterpulsation device
Intraaortic balloon pump
