经皮心肺支持系统抢救心源性休克

Percutaneous cardiopulmonary support （PCPS） system for rescuing dogs with acute cardiogenic shock

目的观察经皮心肺支持系统（PcPs）对心源性休克（cs）犬的生命支持作用，为临床应用提供理论依据。方法健康杂种犬20只，运用随机数字表法随机分为实验组和对照组。所有动物均通过开胸结扎冠状动脉的方法建立急性心源性休克动物模型，以平均动脉压（MAP）降低至基础血压的70％或心输出量（CO）减少30％为建模成功标准。对照组给予常规治疗：机械通气，静脉用多巴胺、多巴酚丁胺或去甲肾上腺素等血管活性药物，静滴5％碳酸氢钠，电击除颤等。实验组给予常规治疗和经皮穿刺体外循环辅助支持治疗。于建模前，建模成功（治疗即刻），治疗后15，30，60，90min通过Swan-Ganz导管监测血流动力学变化，包括平均动脉压（MAP），心输出量（CO），中心静脉压（CVP）；抽取动脉血测定血液酸碱度（pH值），动脉氧分压（PaO2），动脉二氧化碳分压（PaCO2）。采用t检验和方差分析方法比较两组问各指标的变化，P〈0．05为差异有统计学意义。结果18只犬成功建立动物模型。①与建模成功时比较，对照组的MAP，CO于30min，PaO2于60min，pH于90min明显下降（P〈0．05），而CVP于30min，PaCO2于60min明显升高（P〈0．05）。实验组MAP，PaO2于15min明显增加（P〈0．05）；CVP于15min，PaCO2于30min明显下降（P〈0．05）；CO，pH值变化无统计学意义。②与对照组比较，实验组Pa02于15min，MAP，CO于30min，pH值于60min明显升高（P〈0．05），CVP于15min，PaCO2于30min明显降低（P〈0．05）。结论经皮心肺支持系统可以明显改善心源性休克动物的血流动力学状况和氧供指标。

Objective To evaluate the effects of PCPS on life-support of dogs with acute cardiogenic shock （CS）. Method Twenty healthy hybrid dogs were randomly （random number） divided into two groups. The acute CS canine model was established by ligature of the LAD coronary artery via open-chest surgery. The criteria of successful model were blood pressure dropped to 70% of the MAP or cardiac output dropped 30%. Dogs in the experimental group were treated with routine treatment including mechanical ventilation, intravenous injection of vasoactire drugs such as dopamine, dobutamine and norepinephrine, and 5 % bicarbonate as well as defibrillation along with PCPS. While dogs in control group were treated with routine treatment alone. Before modeling and at the beginning of modeling, 15 min, 30 rain, 60 rain and 90 min after routine treatment, the hemodynamic variables in- cluding pH, PaO2 and PaCO2 were measured. The differences between two groups were compared using t -test and ANOVA. Results Eighteen CS models were successfully made. （1） In the control group, MAP, CO deceased significantly （ P 〈 0.05） and CVP increased significantly （ P 〈 0.05 ） within 30 min after modeling, PaO2 decreased significantly （ P 〈 0.05） and PaCO2 increased significantly （ P 〈 0.05） within 60 min after modeling, and pH decreased significantly （P 〈 0.05） within 90 min after modeling. （2） In the experimental group, MAP and Pa02 increased significantly, and CVP decreased significantly （ P 〈 0.05 ） within 15 rain after modeling, and PaC02 decreased significantly （ P 〈 0.05） within 30 min after modeling, and CO and pH remained unchanged. Compared with the control group, Pa02 in experimental group was significantly higher （ P 〈 0.05） and CVP was lower （P 〈0.05） within 15 min, MAP and CO were higher and PaCO2 was lower （P 〈 0.05） within 30 min, and pH was higher （ P 〈 0.05） within 60 min after modeling. Conclusions PCPS improves the hemodynamics and oxygen saturation in dogs with CS.