急性心筋梗塞後ショックに対する補助循環法に関する実験的研究 : IABPと左室バイパスとの対比
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概要
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Effects of mechanical circulatory assistance such as intraaortic balloon pumping (IABP) and left heart bypass (LHB) were studied on mangrel dogs with cardiogenic shock due to acute myocardial infarction (AMI). Bypass flow rate was maintained at the leveal of 30% of the total systemic blood flow in LHB. The evaluation of these ciculatory assistances in those conditions was made by hemodynamics (Blood pressure, Cardiac output, LVedp, MaxLV dp/dt)and EVR (endocardial viability ratio, DPTI/TTI) and myocardial metabolism such as lactate extraction rate (arterial-coronary sinus lactate difference/arterial lactate×100%). (Materials and Methods) Thirty-five mongrel dogs were used in this study and AMI was made by multiple ligations of the coronary arteries. Those dogs were classified 3 groups according to the following three situations and observed for 120 minutes. Group I (11 dogs) was done only Iigations of the coronary artery as a control group. Group II (10 dogs) and group III (14 dogs) were treated by IABP or LHB during 120 minutes as experimental group. The infarcted area of the myocardium produced by ligations of the coronary arteries was clearly mesured by means of the postmortem angiography and the nitroblue tetrazolium staining. (Results and Conclusion) 1. In group I, hemodynamics and the myocardial metabolism was gradually deteriorated after the onset of AMI. 2. In group II, a marked improvement of hemodynamics and myocardial metabolism was clearly observed after the initiation of IABP. 3. In group III, effects of LHB on the myocardial metabolism and EVR could be confirmed, though not so effective in comparison with that of IABP. When the flow rate of left heart bypass reached 40 to 50% of total systemic blood flow, effects of LHB were superior to ones of IABP. 4. In the case with EVR below 0.7, the value of LE% indicated negative. That is, the remarkable anaerobic changes of myocardial metabolism could be observed. From these findings, it was concluded that the mechanical circulatory assistance such as IABP or LHB was obviously effective against the cardiogenic shock following acute myocardial infarction and clinical application should be recommended.
- 神戸大学の論文