CAJ | 학술논문

目的　比较左心室辅助装置(LVAD)和双心室辅助装置(BVAD)对缺血心肌再灌注后心脏血流动力学、心肌能量代谢物质和心肌超微结构中线粒体形态的影响。　方法　将16只绵羊随机分为LVAD组和BVAD组，每组8只，常温阻断升主动脉25分钟，造成双心室缺血损伤的动物模型。结扎右颈内动脉远端，在心脏复跳后应用转子泵分别行LVAD(左心室-右颈内动脉径路)和BVAD(左心室-右颈内动脉和右心室-肺动脉径路)辅助循环120分钟。测定血流动力学、心肌三磷酸腺苷、磷酸肌酸，观察心肌超微结构变化。　结果　施行BVAD或LVAD辅助循环的同时增加容量负荷能够显著改善心脏血流动力学，但LVAD组右心房压显著高于BVAD组(P＜0.05)；BVAD组右心室心肌三磷酸腺苷、磷酸肌酸含量和心肌线粒体比表面值均高于LVAD组(P＜0.05)。　结论　BVAD比LVAD更有助于促进双心室缺血损伤心肌的功能恢复。
목적　비교좌심실보조장치(LVAD)화쌍심실보조장치(BVAD)대결혈심기재관주후심장혈류동역학、심기능량대사물질화심기초미결구중선립체형태적영향。　방법　장16지면양수궤분위LVAD조화BVAD조，매조8지，상온조단승주동맥25분종，조성쌍심실결혈손상적동물모형。결찰우경내동맥원단，재심장복도후응용전자빙분별행LVAD(좌심실-우경내동맥경로)화BVAD(좌심실-우경내동맥화우심실-폐동맥경로)보조순배120분종。측정혈류동역학、심기삼린산선감、린산기산，관찰심기초미결구변화。　결과　시행BVAD혹LVAD보조순배적동시증가용량부하능구현저개선심장혈류동역학，단LVAD조우심방압현저고우BVAD조(P＜0.05)；BVAD조우심실심기삼린산선감、린산기산함량화심기선립체비표면치균고우LVAD조(P＜0.05)。　결론　BVAD비LVAD경유조우촉진쌍심실결혈손상심기적공능회복。
Objective To compare the effects of biventricular assist devices (BVAD) and left ventricular assist devices(LVAD) on enhancing the myocardial recovery in an acute ovine model of global myocardial ischemia. Methods Sixteen adult sheep were randomly divided into LVAD group (n=8) and BVAD group (n=8). BVAD group consisted of left ventricle-right carotid artery bypass and right ventricle-pulmonary artery bypass. Two roller pumps with heat exchanger were used. LVAD group was connected from the apex of left ventricle and returned blood flow to the right carotid artery, and a roller pump. The aorta was clamped 25 minutes to produce a global ischemic injury after cross clamp was released. In both BVAD and LVAD group, the bypass was continued for an additional 120 minutes of reperfusion before further measurements were done. Hemodynamic changes, adenosine triphosphate and creatine phosphate were measured. Myocardial ultrastructure were observed. Results　LVAD could maintain nearly normal circulation with high right atrial pressure by volume loading. However, BVAD group showed superiority in hemodynamics changes. Adenosine triphosphate and creatine phosphate of the right ventricular myocardium in the BVAD group was higher than that of LVAD group (P＜0.05). Myocardial ultrastructural damage in BVAD group was milder than that of LVAD group. The data showed that specific surface-value of mitochondria of right ventricle myocardium was higher in BVAD group than that of LVAD group (P＜0.05).　Conclusion BVAD is superior to LVAD for biventricular global ischemia.