ECMO流量变化的影响肺毛细血管压在心脏性冲击患者
Ouriel Saura1, Guillaume Hékimian1, Grégoire Del Marmol1
1Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France.
增加股骨-股骨静脉体外膜氧化 (VA-ECMO) 流量通常不会增加肺毛细血管压 (PCWP). 在大多数患者中,VA-ECMO流量变化对PCWP具有中性影响,大约三分之一的患者观察到下降.
科学领域:
- 心血管医学 心血管医学
- 关键护理医学 关键护理医学
- 支持心肺血管的支持.
背景情况:
- 股骨-股骨静脉外体膜氧化 (VA-ECMO) 对肺毛细血管压 (PCWP) 的血动力学影响尚不清楚.
- 假设高VA-ECMO流量会增加PCWP和肺风险,但体内数据有限.
研究的目的:
- 评估不同股骨-股骨VA-ECMO流速对PCWP和其他血液动力学参数的影响.
- 在早期VA-ECMO支持期间研究心脏病性休克患者的这些影响.
主要方法:
- 展望性,单中心干预性研究 (ECMO-Flow试验) 涉及80名患者.
- 逐步增加VA-ECMO流量从2到4升/分钟,通过肺动脉导管进行血液动力学评估,心声学和血液气体分析.
主要成果:
- 在36%的患者中,PCWP下降,在58%的患者中保持稳定,尽管左心室 (LV) 后负载增加,但仅在6%的患者中增加.
- 中枢静脉压力 (CVP) 显著下降;右心室 (RV) 后负荷没有变化.
- 索引中风体积下降,心肌工作保持稳定;PCWP减少与更好的基线LV/RV功能和较低的CVP有关.
结论:
- 增加VA-ECMO流量增加PCWP的潜力往往被减少的右心室 (RV) 前置负荷所抵消.
- 对PCWP的净影响通常是中性的,大约三分之一的患者下降,不经常增加.
- 这些发现挑战了假设,即更高的VA-ECMO流量始终会提高PCWP.
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