静脉-静脉体外膜肺氧合联合房间隔造口术治疗右心衰竭的实验研究

doi:10.3969/j.issn.1002-1949.2018.06.017

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摘要目的探讨静脉-静脉体外膜肺氧合（VV-ECMO）联合房间隔造口术对急性右心衰竭犬的治疗效果。方法随机将12只犬分为急性右心衰竭对照组（对照组，n=6）和VV-ECMO联合房间隔造口术治疗组（治疗组，n=6），麻醉后行胸廓切开术，分别放置相应测压导管以监测左心房压力（LAP）、肺动脉压力（PAP）及右心室平均压力（MRVP）。将血管流量超声探头分别置于升主动脉和肺动脉外周以测量心输出量（CO）和肺动脉流量（QPA），分别测量出基础值。治疗组在建立体外循环后进行房间隔造口术，随后将体外循环改为VV-ECMO转流。两组均逐渐套扎肺动脉使QPA分别降至基础值的60%、40%和0，每降一个程度均保持30 min，并测量血流动力学相关指标。结果两组各种血流动力学指标基础值之间差异无统计学意义（P均>0.05）。对照组CO于QPA降至60%和40%时明显下降，并且明显低于治疗组（P均<0.05），治疗组CO在QPA下降过程中则无明显变化（P均>0.05）。在QPA降至60%和40%时，两组的PAP和MRVP均明显增加，另外，对照组的LAP和MAP均明显下降（P均<0.05），而治疗组的LAP和MAP则无明显下降。除PAP外，治疗组各项血流动力学参数在QPA降至40%时均明显优于对照组（P均<0.05）。结论 VV-ECMO联合房间隔造口术可有效改善肺动脉阻力增高所致急性右心衰竭犬的血流动力学，为临床治疗急性右心衰竭提供了一种新的治疗选择。

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	郑俊波
	温良鹤
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	娄邵菲
	叶明
	于凯江

关键词 ：体外膜肺氧合（ECMO）, 房间隔造口术, 右心衰竭（RHF）

基金资助:黑龙江省教育厅科学技术研究项目（12531287）

作者简介: 郑俊波（1982-），男，硕士，主治医师，E-mail： icuzhengjunbo@126.com。

引用本文:

郑俊波，温良鹤，戴青青，姜雪松，娄邵菲，叶明，于凯江. 静脉-静脉体外膜肺氧合联合房间隔造口术治疗右心衰竭的实验研究[J]. 中国急救医学, 2018, 38(6): 539-.
Zheng Jun-bo, Wen Liang-he, Dai Qing-qing, Jiang Xue-song, Lou Shao-fei, Ye Ming, Yu Kai-jiang. The experimental study on using of venovenous extracorporeal membrane oxygenation and atrial septostomy for right heart failure. Chinese Journal of Critical Care Medicine, 2018, 38(6): 539-.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.06.017 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I6/539

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