由VA-ECMO诱导的血液动力学,心脏能量和细胞信号通路的变化,随着左心室活性卸载或不随着左心室活性卸载
Antoine Beurton1, Elora Bordier2, Simon Veyret1
1CHU Bordeaux, Department of Cardiovascular Anesthesia and Critical Care, CHU de Bordeaux, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, BMC, U1034, F-33600 Pessac, France.
将左心室 (LV) 卸载添加到静脉动脉外体膜氧化 (VA-ECMO) 中,可以减少LV过载并改善心脏能量. 这种方法可以通过激活心脏保护通路来增强心肌恢复.
科学领域:
- 心血管研究研究心血管研究
- 机械循环支持 机械循环支持
- 心脏外科手术 心脏外科手术
背景情况:
- 静脉动脉外体膜氧化 (VA-ECMO) 对于心脏性休克 (CS) 至关重要,但可以恶化左心室 (LV) 状况.
- 辅助LV卸载策略旨在通过激活心脏保护通路来改善心肌恢复.
研究的目的:
- 为了研究是否添加一个内动脉气球 (IABP) 或Impella到VA-ECMO减轻LV过载和改善心脏能量.
- 通过这些结合策略来评估风险/安全路径的调节.
主要方法:
- 在绵羊中,通过冠状动脉酒精化诱导严重的CS.
- 动物被随机分配到单独使用VA-ECMO,使用IABP进行VA-ECMO或使用Impella进行VA-ECMO.
- ECMO血流量从基线心脏输出量的25%增加到100%.
主要成果:
- 与单独使用VA-ECMO相比,IABP和Impella都降低了LV末端透气压.
- 使用Impella,但不使用IABP,降低了LV体积和改善了心脏能量.
- 结合策略组中ERK和Akt的酸化率较高,但心脏病发作大小和亡没有差异.
结论:
- 积极的LV卸载与VA-ECMO相结合,有效地减少LV过载并增强心脏能量.
- 这些策略积极调节心脏保护信号通路,有助于心肌恢复的理解.
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