IABP的实用学习课件.pptxVIP

IABP的实用学习课件第1页/共56页第2页/共56页IABP历史1953年Kantrowitz提出应用机械辅助心脏，将动脉收缩时 压力波的相位延迟到舒张期，以增加冠状动脉的供血1958年Bartwell等提出用主动脉反搏（Counterpulation)的 设想1961年Jacoby在动物实验中证实了反搏法对急性冠状血管 阻塞的疗法，但技术方面受到很大限制，且有严 重溶血1962年Moulopoulous提出将带球囊的导管放入主动脉内。1970年Goetz发明双球囊导管，以产生单向血流1978年Bregman发明经皮主动脉内球囊导管。第3页/共56页主动脉内球囊反搏(Intra-aortic balloon pump IABP) 机械辅助循环方法之一,系通过动脉系统植入一根带气囊的导管到降主动脉内左锁骨下动脉开口的远端,在舒张期气囊充气,在心脏收缩期前气囊排气,起到辅助衰竭心脏的作用.第4页/共56页一、主动脉内球囊反搏的 工作原理第5页/共56页VentricularEjectionPhaseAtrialSystoleVentricularFillingIsovolumetricContractionIsovolumetricRelaxation120Semi-LunarValve ClosesSemi-LunarValve Opens 100Arterial Pressure8060Pressure (mm Hg)40AV ValveCloses AV ValveOpens10Ventricular Pressure0RElectrocardiogramTPSQAtrialSystole VentricularSystole DiastoleApprox. Time 0 0.1 0.20.3 0.40.5 0.60.70.8 Arterial Pressure Curve? Datascope Corp.第6页/共56页Left Coronary Artery 300200Coronary Blood Flow (ml/min)Right Coronary Artery1000DiastoleSystole Slide courtesy of A.C. Guyton, MD, Textbook of Medical Physiology, Sixth Edition, 1981 W.B. Saunders Company ? Datascope Corp.第7页/共56页120收缩压mm HgV 型切迹100脉压平均压80舒张压收缩期舒张期主动脉血压波形? Datascope Corp.第8页/共56页SupplyDemandCoronary artery anatomy Diastolic pressure Diastolic time Extraction HBG PaO2 Heart rateAfterloadPreloadContractility MVO2DETERMINANTS OF MYOCARDIAL OXYGEN SUPPLY AND DEMAND第9页/共56页Pumping Efficiency LV Volume Pressure Baroreceptors ActivateVasoconstriction HRRelease of Catecholamines DemandAfterload (SVR)Supply O2 DemandPreload (LVEDP)MVO2Left Ventricular Failure第10页/共56页C.O. Glomerular Filtration Pressure Activation of Renin-Angiotensin-Aldosterone-ADH Hypervolemia NA+ H2O Reabsorption Afterload (SVR)Demand Preload (LVEDP) O2 DemandC.O.Supply HR O2 SupplyMVO2Pulmonary Artery Pressure? Datascope Corp.第11页/共56页Pulmonary EdemaOxygenationContractilityTissue HypoxiaC.O.DemandBPAnaerobic MetabolismLactic Acid ProductionSupplyTissue AcidosisMVO2Tissue AnoxiaDeath? Datascope Corp.第12页/共56页I