超声引导双心房输注技术对犬急性肺动脉高压血流动力学的影响

Effects of Ultrasound-Guided Biatrial Infusion on Hemodynamics in Dogs with Acute Pulmonary Hypertension

目的探讨超声引导双心房输注技术对犬急性肺动脉高压(APH)血流动力学的影响。方法将健康成年杂种犬10只按随机数字表法分为超声引导组(A组)、开胸组(B组)2组,每组5只。2组均采用氯胺酮10mg·kg-1肌内注射进行麻醉,按经肺动脉注入血栓栓塞法建立犬APH模型,建模成功后:A组通过Swan-Ganz漂浮导管至右心房给予前列腺素E1脂微球载体制剂(Lipo-PGE1)20ng·kg-1·min-1,通过超声引导,经股动脉逆行置入左心导管至左心房,给予去氧肾上腺素2μg·kg-1·min-1;B组通过Swaw-Ganz导管至右心房给予A组相同剂量的前列腺素E1脂微球载体制剂,经胸正中切口开胸,经左心耳分别插入左心导管,给予A组相同剂量去氧肾上腺素。测量2组麻醉前(T1),建模成功后给药前(T2),给药后10min(T3)、30min(T4)、60min(T5)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)和心排出量(CO),计算心指数(CI)、全肺阻力指数(PVRI)和体循环阻力指数(SVRI),并检测各时点的血浆LDH3。结果 2组均制模成功。与T2比较:2组T3-T5时段MPAP、PVRI值均有显著下降(P<0.05);2组T3-T5时段CI、MAP和SVRI值均有所上升,但差异无统计学意义(P>0.05);2组T4、T5时段LDH3值均有显著下降(P<0.05)。各观察指标2组间各时点比较差异均无统计学意义(P>0.05)。结论超声引导双心房输注给予前列腺素E1脂微球载体制剂和去氧肾上腺素能够有效地降低肺动脉高压,同时改善心脏做功,提高CI,降低对体循环血流动力学的影响,改善急性肺动脉高压低心排出量;在减小创伤的同时达到与开胸双心房输注同样效果。

Objective To investigate the effects of ultrasound-guided biatrial infusion on hemodynamics in dogs with acute pulmonary hypertension（APH）. Methods Ten healthy adult mongrel dogs were randomly divided into ultrasound-guided group（group A） and thoraeotomy group （group B） ,with 5 dogs in each group. All dogs were anesthetized with intramuscular injection of ketamine（10 mg . kg-1）. Pulmonary arterial embolism was induced by injection of blood clots to produce APH. After establishment of the dog model of APH,liposomal prostaglandin E1 （20 ng . kg- 1 . min-1） was administrated through the insertion of floating Swan-Ganz catheters into the right atrium and phenylephrine（2 ug . kg-1. min- 1） was administrated through retrograde insertion of catheters into the left atrium under ultrasonic guidance in group A. In group B, liposomal prostaglandin E1（20 ng . kg-1. min -1） was administrated through the insertion of Swan-Ganz catheters into the right atrium and phenylephrine （2 ug . kg-1 . min-1） was administrated through the insertion of catheters into the left atrium in the left atrial appendage after thoracotomy. Heart rate （ HR）, mean arterial pressure （ MAP）, oxygen saturation （SpO2）, central venous pressure（CVP）, mean pulmonary arterial pressure（MPAP）, pulmonary capillary wedge pressure （PCWP）, cardiac output （CO）, cardiac index（CI）, pulmonary vascular resistance index（PVRI）, systemic vascular resistance index（SVRI） and plasma LDH3 levels were determined before anesthesia（T1 ） ,before administration（T2 ）, 10 minutes after administration（T3 ）, 30 minutes after ad- ministration（T4） and 60 minutes after administration（T5）. Results APH was successfully induced in both groups. The MPAP and PVRI at T3, T4 and T5 and the LDHa levels at T4 and T5 significantly decreased compared with T2 （P〈0.05）. The CI,MAP and SVRI at T3 ,T4 and T5 increased compared with T2, but the differences were not significant （P〉0.05）. In addition, there were no significant differences in these parameters between the two groups at all time points（P〉 0.05）. Conclusion Ultrasound-guided biatrial infusion with liposomal prostaglandin E1 and phenylephrine can effectively reduce pulmonary hypertension,improve cardiac work and CO,increase CI,minimize trauma,and decrease the impact on hemodynamic circulation. Moreover, ultrasound- guided biatrial infusion provides the same efficacy as biatrial infusion after thoracotomy.