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Medicine

ards 大型动物模型主动脉和肺动脉血流动力学的侵袭血流动力学监测

Published: November 26, 2018
doi:
10.3791/57405
, , , , , , , ,
1Universitatsklinikum Hamburg-Eppendorf

Summary

我们提出了一个方案, 创造右心室功能障碍的猪模型诱导 ards。我们展示了使用主动脉和肺动脉周围的流动探针对左心室和右心室输出量进行侵入性监测, 以及主动脉和肺动脉的血压测量。

Abstract

心力衰竭患者发病和死亡的主要原因之一是右心室 (rv) 功能障碍, 特别是由于肺动脉高压。为了更好地了解和治疗这种疾病, 对左心室和右心室参数进行精确的血流动力学监测很重要。因此, 有必要建立心脏血流动力学的实验猪模型和测量的研究目的。

本文介绍了利用油酸 (oa) 诱导 ards 和随后的右心室功能障碍, 以及猪的仪器和数据采集过程, 需要评估血流动力学参数。为了实现右心室功能障碍, 我们使用油酸 (oa) 引起 ards, 并伴有肺动脉高压 (pah)。利用该模型可以检测 pah 和连续右心室功能障碍, 可以测量许多血流动力学参数, 并可检测右心室体积负荷。

在整个实验过程中, 包括呼吸率 (rr)、心率 (hr) 和体温在内的所有重要参数都被记录。血流动力学参数, 包括股动脉压力 (fap)、主动脉压 (ap)、右心室压力 (收缩峰值、终末期收缩期和终末期右心室压力)、中心静脉压力 (cvp)、肺动脉压 (pap) 和测量了左动脉压力 (lap) 以及包括主动脉上血流 (aaf) 和肺动脉血流 (paf) 在内的灌注参数。血流动力学测量是使用经心肺热稀释, 以提供心脏输出量 (co)。此外, picc2 系统 (脉冲轮廓心脏输出系统 2) 被用来接收参数, 如中风体积方差 (svv), 脉冲压力方差 (ppv), 以及血管外肺水 (evlw) 和全球终末期舒张体积 (gedv)。我们的监测程序适用于检测右心室功能障碍和监测体积给药前后的血流动力学结果。

Introduction

右心室 (rv) 功能障碍是心力衰竭1患者发病和死亡的主要原因, 特别是如果其根本原因是肺动脉高压 2。rv 将血液注入低阻力肺系统, 这通常与高依从性有关。因此, rv 的特点是收缩压峰值低。与左心室 (lv)3相比, 它还产生六分之一的中风工作。由于其肌肉较薄, rv 很容易受到前后负荷 4,5的变化。rv 收缩和舒张期收缩和松弛的等压相并不像 lv 中那样明显。左心室和右心室血流动力学参数的检查在急性右心窘迫危重患者的治疗中非常重要,4、7, 因为 rv 衰竭会显著增加短期死亡率6。

在确定患者体积状态方面, 使用了心脏静脉压力 (cvp) 和左心室预紧参数 (如肺毛细血管楔形压力 (pcwp) 等预紧参数。最近, 事实表明, 仅有这些参数并不适合检测患者对液体的需求 8、9、10.认识到液体反应能力对于检测和治疗 rv 功能障碍患者的体积剥夺和体积过载至关重要。避免体积超载对于降低这些患者的重症监护室 (icu) 的死亡率和停留时间至关重要。

通过这项研究, 我们建立了一个猪的右心室功能障碍模型, 是一致的和可复制的。由于它与人类的相似性, 有必要建立一致和可重复的实验大型动物模型的心脏血流动力学和测量的研究目的。

Protocol

汉堡市动物护理和使用委员会批准了这项前瞻性的试验, 在3-6个月大的时候, 有21名麻醉的家养猪 (德国陆地), 体重在40-55 公斤之间 (编号 18/17)。根据 arrive 准则, 所有实验都按照《实验室动物护理和使用指南》 (国家卫生研究院第86-23 出版物, 1996年修订)11进行了护理。 1. 流量探头两点校准 将流动探头放入去离子水中, 并将探头连接到跨音速流动探针系?…

Representative Results

我们的动物模型显示了猪血流动力学参数的广泛变化。由于它的大小和血流动力学相似, 人们可以很容易地使用完全相同的设备, 在人类使用, 以获得类似的结果。然而, 麻醉值是基于经验, 并可能改变的基础上, 体重/年龄/应变的猪。 应咨询兽医来评估麻醉方案。 以往 oa 诱导的急性肺损伤 (ali) 模型结果不一致 13</s…

Discussion

ards, 加上肺动脉高压, 是一种非常致命的疾病。对于患有这种疾病的患者, 有必要提供更多关于治疗的信息。在与生物合作和研究时, 尽可能理智是非常重要的。在这种情况下, 有必要在一个实验中收集尽可能多的信息。

在这样的开放跳动的心脏模型中, 有一些关键的手术步骤。为了不不必要地使用猪, 必须有一个经验丰富的外科医生来解剖心脏骨架之间的上升主动脉和肺动脉, …

Disclosures

The authors have nothing to disclose.

Acknowledgements

提交人没有得到任何承认。

Materials

Animal Bio Amp ADInstruments FE136
Quad BridgeAmp ADInstruments FE224
Power Lab 16/35 ADInstruments 5761-E
LabChart 8.1.8 Windows ADInstruments
Pulmonary artery catheter 7 F Edwards Lifesciences Corporation   131F7 
Prelude Sheath Introducer 8 F Merit Medical Systems, Inc. SI-8F-11-035
COnfidence Cardiac Output Flowprobes Transonic AU-IFU-PAUProbes-EN Rev. A 4/13
Adrenalin Sanofi 6053210
Oleic acid Sigma Aldrich 112-80-1
Magnesium Verla Verla 7244946
Ketamin Richter Pharma AG BE-V433246
Azaperon Sanochemia Pharmazeutika AG QN05AD90
Midazolam Roche Pharma AG 3085793
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Tags

Keywords: Invasive Hemodynamic MonitoringAortic HemodynamicsPulmonary Artery HemodynamicsARDSLarge Animal ModelCritical CareHeart FailureSepsisRespiratory FailureSeldinger TechniqueArterial CatheterPulmonary Artery CatheterMillar Tip CatheterBladder CatheterOpen Heart SurgeryAnesthesiaCardiac SurgeryIntensive Care Medicine
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Kluttig, R., Friedheim, T., Behem, C., Zach, N., Brown, R., Graessler, M., Reuter, D., Zöllner, C., Trepte, C. Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS. J. Vis. Exp. (141), e57405, doi:10.3791/57405 (2018).
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