新型主动脉旁反搏与主动脉内球囊反搏装置对急性心衰的比较实验研究

Comparison of a new para-aortic counterpulsation device with the intra-aortic balloon pump in an acute heart failure animal model

目的比较主动脉旁反搏装置(PACD)与主动脉内球囊反搏(IABP)装置对急性心衰动物模型的辅助效果。方法选取8只健康成年小尾寒羊,体重(44.6±3.9)kg,雌雄不拘。将自制PACD(每搏量为55 ml)的无瓣人工血管出口吻合于降主动脉,同时于降主动脉内植入IABP装置球囊(每搏量为40 ml),分别连接至IABP装置控制台。PACD及IABP装置均依靠体表心电图触发,并用主动脉压波形对反搏时相进行调节。结扎冠脉分支建立急性心衰动物模型,采集PACD及IABP装置反搏前后血流动力学指标变化。结果 IABP装置及PACD辅助后,主动脉收缩压(SAP)分别下降了4.88%,11.58%(P<0.05)。左室舒张末压(LVEDP)分别降低了12.71%,21.78%(P<0.05)。辅助舒张压扩大峰值(PADP)分别增加了11.1%,25.76%(P<0.05)。心内膜活力比率(EVR)分别增加了23.51%,45.72%(P<0.05)。左颈动脉血流量(LCAF)及冠状静脉回心血量(CSF)分别增加6.05%,12.10%及10.43%,20.03%(P<0.05)。结论 PACD及IABP装置对急性心衰动物均有辅助作用,但PACD更显著降低了左室后负荷,增加了心肌、脑的灌注,是一种更有效的反博辅助装置。

OBJECTIVE o compare the efficacy of para-aortic counterpulsation device（PACD） and intra-aortic balloon pump（IABP） in acute heart failure animal model.METHODS Eight healthy adult sheep,weighting（44.6±3.9）kg,was successfully induced in acute heart failure by snaring branches of coronary arteries.PACD,consisting of a blood chamber（55 ml）,was anastomosed to descending thoracic aorta through a no valve graft.In parallel,an intra-aortic balloon（40 ml） was placed in the descending thoracic aorta.Both devices were pneumatically driven with an IABP console that was trigged by the electrocardiogram.The hemodynamics parameters for both devices before and after counterplusation were recorded.RESULTS The PACD provided up to 11.58% reduction in systolic aortic pressure（SAP） and 21.78% reduction in left ventricular end-diastolic pressure（LVEDP） while IABP provided up to 4.88% and 12.71% reduction respectively.Peak-augmented diastolic pressure（PADP） and endocardiac viability ratio（EVR） were increased by 25.76% and 45.72% respectively in PACD assisting,while by 11.1% and 23.51% respectively in IABP.PACD also increased left carotid artery flow（LCAF） by 10.43 % and coronary sinus flow（CSF） by 20.03%,while IABP increased by 6.05% in LCAF and by 12.10% in CSF.CONCLUSION Both the PACD and IABP provide effective circulatory support for animal model of acute heart failure,while PACD has better performances comparing with IABP.