猪模型中闭合胸部双心室压力-体积循环记录与导管
Summary
在这里，我们提出了一种闭合胸部方法，用于急性右心室功能不全猪的基于入院的双室压力 – 体积环记录。
Abstract
压力容积 （PV） 回路记录可对心室表现的负荷无关变量进行最先进的研究。单心室评估通常在临床前研究中进行。然而，由于左右心室的平行和连续连接，左右心室发挥功能上的相互依存性，鼓励同时评估两个心室。此外，各种药物干预可能会以不同的方式影响心室及其前负荷和后负荷。
我们描述了在急性右心室 （RV） 超负荷的猪模型中，对基于入院的双心室 PV 环记录的闭胸方法。我们利用微创技术，所有血管通路均由超声波引导。PV导管在荧光镜引导下放置，以避免动物开胸，因为闭合胸部进路可维持相关的心肺生理学。导纳技术提供实时PV环路记录，无需事后处理。此外，我们还解释了在所介绍过程的关键时间点的一些基本故障排除步骤。
所提出的方案是一种可重复且生理相关的方法，可在大型动物模型中获得双心室心脏PV环记录。这可以应用于各种各样的心血管动物研究。
Introduction
压力-容积 （PV） 回路包含大量血流动力学信息，包括收缩末期和舒张末期压力和血容量、射血分数、卒中量和卒中功1。此外，瞬态预载荷降低创建了一系列环路，从中可以导出与负载无关的变量2，3。这种与负荷无关的心室功能评估使PV环路记录成为血流动力学评估中最先进的。PV环路记录可以在人类身上进行，但主要用于并推荐用于临床前研究4，5，6。
压力-容积环路可从右心室 （RV） 和左心室 （LV） 获得。大多数研究假设都集中在单个心室上，导致仅记录单心室PV环7，8，9，10。然而，左右心室由于在紧绷心包内有连续和平行连接而导致收缩期和舒张期相互依赖性11。一个心室的输出量或大小的变化将影响另一个心室的大小、负荷条件或灌注。因此，双心室PV环记录可以更全面地评估心脏总表现。药物干预也可能对两个心室及其负荷状况产生不同的影响，进一步强调了双心室评估的重要性。
PV 导管可通过多种途径进入任一心室，包括从心脏顶端或通过 RV 流出道进入的开胸入路7、10、12、13、14。然而，胸部的开口会影响生理状况，并可能引入偏倚。
根据我们先前研究的经验15，16，17，18，我们的目标是在急性房车衰竭的大型动物模型中展示我们的闭胸双心室PV环记录方法，对心肺生理学的影响最小（图1）。
Protocol
该协议是根据丹麦和机构关于动物福利和伦理的指导方针制定和使用的。丹麦动物研究监察局批准了该研究（许可证号：2016-15-0201-00840）。使用了约60公斤的丹麦雌性屠宰猪（Landrace，Yorkshire和Duroc的杂交品种）。 1. 麻醉和通气 用Zoletil混合物1 mL / kg（ 见材料表）作为肌内注射预先麻醉清醒的猪，以减少动物在运输过程中的压力，疼痛和焦虑。 将动…
Representative Results
本说明描述了一种在大型动物中实现来自RV和LV的基于导纳的PV记录的方法。 为了比较我们在RV和LV中的同时PV记录，我们对来自我们最大研究的双心室CO测量值进行了线性回归18 ，同时进行RV CO和LV CO测量的数量最多（来自12只动物的n = 379个记录）。我们发现斜率为1.03（95%CI 0.90-1.15），Y截距为695（95%CI -2-1392），r2= 0.40。这表明每个心室中PV导管测量的CO…
Discussion
本文介绍了一种可重复的微创闭合胸入路，用于双心室压力-体积环记录。
将PV导管从RA推进到RV是该协议中最关键的步骤。RV的复杂组成和导管的刚度使插入易于膨胀和几何上具有挑战性的RV变得复杂。这种困难可以解释为什么通常首选开胸器械。在试点研究期间，尝试并放弃了许多通路和技术，包括右颈外静脉通路，胸骨上通路进入上腔静脉和下腔静脉。根据这些试点研究，…
Divulgazioni
The authors have nothing to disclose.
Acknowledgements
这项工作得到了挪度急性医学基金会（3374），Holger和Ruth Hesse的纪念基金会，Søster和Verner Lippert基金会，诺和诺德基金会（NNF16OC0023244，NFF17CO0024868）和阿尔弗雷德·本松基金会的支持。
Materials
| 12L-RS | GE Healthcare Japan | 5141337 | Ultrasound probe |
| Adhesive Aperature Drape (OneMed) | evercare | 1515-01 | 75 x 90 cm (hole: 6 x 8 cm) |
| Alaris GP Guardrails plus | CareFusion | 9002TIG01-G | Infusion pump |
| Alaris Infusion set | BD Plastipak | 60593 | |
| Alkoholswap | MEDIQ Danmark | 3340012 | 82% ethanol, 0,5% chlorhexidin, skin disinfection |
| Amplatz Support Wire Guide Extra-Stiff | Cook Medical | THSF-25-260-AES | diameter: 0.025 inches, length: 260 cm |
| BD Connecta | BD | 394601 | Luer-Lock |
| BD Emerald | BD | 307736 | 10 mL syringe |
| BD Luer-Lock | BD Plastipak | 300865 | BD = Becton Dickinson, 50 mL syringe |
| BD Platipak | BD | 300613 | 20 mL syringe |
| BD Venflon Pro | Becton Dickinson Infusion Therapy | 393204 | 20G |
| BD Venflon Pro | Becton Dickinson Infusion Therapy | 393208 | 17G |
| Butomidor Vet | Richter Pharma AG | 531943 | 10 mg/mL |
| Check-Flo Performer Introducer | Cook Medical | RCFW-16.0P-38-30-RB | 16 F sheath, 30 cm long |
| Cios Connect S/N 20015 | Siemens Healthineers | C-arm | |
| D-LCC12A-01 | GE Healthcare Finland | Pressure measurement monitor | |
| Durapore | 3M | – | Adhesive tape |
| E-PRESTIN-00 | GE Healthcare Finland | 6152932 | Respirator tubes |
| Exagon vet | Richter Pharma AG | 427931 | 400 mg/mL |
| Fast-Cath Hemostasis Introducer 12F | St. Jude Medical | 406128 | L: 12 cm |
| Favorita II | Aesculap | Type: GT104 | |
| Fentanyl | B. Braun | 71036 | 50 mikrogram/mL |
| Ketaminol Vet | MSD/Intervet International B.V. | 511519 | 100 mg/mL |
| LabChart | ADInstruments | Data aquisition software | |
| Lawton 85-0010 ZK1 | Lawton | Laryngoscope | |
| Lectospiral | VYGON | 1159.90 | 400 cm (Luer-LOCK) |
| Lubrithal eye gel | Dechra, Great Britain | ||
| MBH qufora | MBH-International A/S | 13853401 | Urine bag |
| Natriumklorid | Fresenius Kabi | 7340022100528 | 9 mg/ml Isotonic saline |
| PICO50 Aterial Blood Sampler | Radiometer | 956-552 | 2 mL |
| Portex Tracheal Tube | Smiths Medical | 100/150/075 | "Cuffed Clear Oral/Nasal Murphy Eye" |
| PowerLab 16/35 | ADInstruments | PL3516 | Serial number: 3516-1841 |
| Pressure Extension set | CODAN | 7,14,020 | Tube for anesthetics, 150 cm long, inner diameter 0.9 mm |
| Propolipid | Fresenius Kabi | 21636 | Propofol, 10 mg/mL |
| PTS-X | NuMED Canada Inc. | PTSX253 | Inferior vena cava balloon |
| Radiofocus Introducer II | Radiofocus/Terumo | RS+B80N10MQ | 6+7+8F sheaths |
| Rompun Vet | Beyer | 86450917 | Xylazin, 20 mg/mL |
| Rüsch Brilliant AquaFlate Glycerine | Teleflex | 178000 | Bladder catheter, size 14 |
| S/5 Avance | Datex-Ohmeda | – | Mechanical ventilator |
| Safersonic Conti Plus & Safergel | SECMA medical innovation | SAF.612.18120.WG.SEC | 18 x 120 cm (Safersonic Sterile Transducer Cover with Adhesive Area and Safergel) |
| Scisense Catheter | Transonic Scisense | FDH-5018B-E245B | Serial number: 50-533. Pressure-volume catheter |
| Scisense Pressure-Volume Measurement System | Transonic Scisense | ADV500 | Model: FY097B. Pressure-volume box |
| Swan-Ganz CCOmbo | Edwards Lifesciences | 744F75 | 110 cm |
| TruWave Pressure Monitoring Set | Edwards Lifesciences | T434303A | 210 cm |
| Vivid iq | GE Medical Systems China | Vivid iq | |
| Zoletil 50 Vet (tiletamin 125 mg and zolazepam 125 mg) | Virbac | 83046805 | Zoletil Mix for pigs: 1 vial of Zoletil 50 Vet (dry matter); add 6.25 mL Xylozin (20 mg/mL), 1.25 mL ketamin (100 mg/mL) and 2.5 mL Butorphanol (10 mg/mL). Dose for pre-anesthesia: 10 mL/10 kg as intramuscular injection |
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Citazione di questo articolo
Lyhne, M. D., Schultz, J. G., Dragsbaek, S. J., Hansen, J. V., Mortensen, C. S., Kramer, A., Nielsen-Kudsk, J. E., Andersen, A. Closed Chest Biventricular Pressure-Volume Loop Recordings with Admittance Catheters in a Porcine Model. J. Vis. Exp. (171), e62661, doi:10.3791/62661 (2021).