CAJ | 학술논문

目的观察经皮心肺支持系统(PCPS)对心源性休克(CS)犬的牛命支持作用,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(NAP)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15,30,60,90 min通过Swan-Ganz导管监测血流动力学变化,包括平均动脉压(NAP),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(PaO_2),动脉二氧化碳分压(PaCO_2).采用t检验和方差分析方法比较两组间各指标的变化,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30 min,PaO_2于60 min,pH于90 min明显下降(P＜0.05),而CVP于30 min,PaCO_2于60 min明显升高(P＜0.05).实验组MAP,PaO_2于15 min明显增加(P＜0.05);CVP于15 min,PacO2于30 min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PaO_2于15 min,MAP,CO于30 min,pH值于60 min明显升高(P＜0.05),CVP于15 rain,PaCO_2于30 min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.
목적 관찰경피심폐지지계통(PCPS)대심원성휴극(CS)견적우명지지작용,위림상응용제공이론의거.방법 건강잡충견20지,운용수궤수자표법수궤분위실험조화대조조.소유동물균통과개흉결찰관상동맥적방법건립급성심원성휴극동물모형,이평균동맥압(NAP)강저지기출혈압적70%혹심수출량(CO)감소30%위건모성공표준.대조조급여상규치료:궤계통기,정맥용다파알、다파분정알혹거갑신상선소등혈관활성약물,정적5%탄산경납,전격제전등.실험조급여상규치료화경피천자체외순배보조지지치료.우건모전,건모성공(치료즉각),치료후15,30,60,90 min통과Swan-Ganz도관감측혈류동역학변화,포괄평균동맥압(NAP),심수출량(CO),중심정맥압(CVP);추취동맥혈측정혈액산감도(pH치),동맥양분압(PaO_2),동맥이양화탄분압(PaCO_2).채용t검험화방차분석방법비교량조간각지표적변화,P＜0.05위차이유통계학의의.결과 18지견성공건립동물모형.①여건모성공시비교,대조조적MAP,CO우30 min,PaO_2우60 min,pH우90 min명현하강(P＜0.05),이CVP우30 min,PaCO_2우60 min명현승고(P＜0.05).실험조MAP,PaO_2우15 min명현증가(P＜0.05);CVP우15 min,PacO2우30 min명현하강(P＜0.05);CO,pH치변화무통계학의의.②여대조조비교,실험조PaO_2우15 min,MAP,CO우30 min,pH치우60 min명현승고(P＜0.05),CVP우15 rain,PaCO_2우30 min명현강저(P＜0.05).결론 경피심폐지지계통가이명현개선심원성휴극동물적혈류동역학상황화양공지표.
Objective To evaluate the effects of PCPS on life-support of dogs with acute cardingenic 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 vasoucfive 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 rain,30 rain,60 rain and 90 rain after routine treatment,the hemodynamic variables including pH,PaO_2 and PaCO_2 were measured.The differences between two groups were compared using t-test and ANOVA.Results Eighteen(25 models were successfully made.(1)In the control group,MAP,CO deceased significantly(P＜0.05)and CVP increased significandy(P＜0.05)within 30 rain after modeling,PaO_2 decreased significantly(P＜0.05)and PaCO_2 increased significantly(P＜O.05)within 60 rain after modeling,and pH decreased significantly(P＜0.05)within 90 rain after modeling.(2)In the experimental group,MAP and PaO_2 increased significantly,and CVP decreased significantly(P＜0.05)within 15 rain after modeling,and PaCO_2 decreased significantly(P＜0.05)within 30 rain after modeling,and CO and pH remained unchanged.Compared with the control group,PaO_2 in experimental group was significantly higher(P＜0.05)and CVP was lower(P＜0.05)within 15 rain,MAP and CO were higher and PaCO_2 waa lower(P＜0.05)within 30 rain,and pH was higher(P＜0.05)within 60 min after modeling.Conclusions PCPS improves the hemodynamics and oxygen saturation in dogs with CS.