Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,主动脉内球囊反搏泵的临床使用,主动脉内球囊反搏泵的临床使用,300,200,100,0,Systole,Diastole,左冠灌注,右冠灌注,Coronary Blood Flow(ml/min),Slide courtesy of A.C.Guyton,MD,Textbook of Medical Physiology,Sixth Edition,1981 W.B.Saunders Company,Datascope Corp.,3002001000Systole Diastole 左冠,心肌的供氧和耗氧,MVO,2,供氧,耗氧,冠脉血管情况,舒张期内的血压,舒张期长度,血氧,:,血红细胞,氧饱和度,心率,后负荷,(,舒张末压,),前负荷,收缩力,心肌的供氧和耗氧MVO2供氧耗氧冠脉血管情况心率,IAB Inflation,IAB Inflation,IAB Deflation,IAB Deflation,IABP,的工作原理,MVO,2,导管充气,-,增加心肌供氧,导管排气,-,降低心肌耗氧,供氧,耗氧,IABP的工作原理MVO2 导管充气-增加心肌供氧供氧耗,40,动脉压力波形,等容收缩,等容舒张,0,120,100,60,心电图,心室压力,动脉压力,Approx.Time,0,0.1,0.2,0.3,0.4,0.5,0.6,0.7,0.8,80,10,房室瓣膜,开启,房室瓣膜,关闭,主瓣关闭,主瓣开启,压力(,mm Hg),心室收缩,心房收缩,舒张期,T,R,P,Q,S,心室充盈,心室注射阶段,心房收缩,40动脉压力波形等容收缩等容舒张012010060心电图心室,切迹点,收缩压,脉搏压力,舒张压,120,100,80,收缩期,舒张期,mm Hg,主动脉压力曲线,切迹点收缩压脉搏压力舒张压12010080收缩期舒张期mm,在使用,IABP,时的动脉压力波形的改变,.,舒张期球囊增压,冠脉灌注,有辅助的舒张末压,MVO,2,需求,有辅助的收缩压,无辅助的收缩压,球囊开始充气,无辅助的舒张末压,140,120,100,80,60,mm,Hg,在使用IABP时的动脉压力波形的改变.舒张期球囊增压有辅助的,IAB,球囊的具体放置位置,IAB球囊的具体放置位置,适应症,1.顽固性(难治的)左心室衰竭,2.,心源性休克,3.,顽固的不稳定心绞痛,适应症1.顽固性(难治的)左心室衰竭,适应症,4.心肌梗死的急性期,5.,由心梗引起的机械性损伤如,:,室间隔穿孔、二尖瓣返流、乳状肌撕裂等,6.,心肌缺血引起的室性心律不齐,适应症4.心肌梗死的急性期,适应症,7.术前为高危外科及,PTCA,的病人提供心脏辅助,8.,败血性休克,9.,协助脱离体外循环机,适应症7.术前为高危外科及PTCA的病人提供心脏辅助,适应症,10.手术过程中产生脉动血流,11.,血管成形术和瓣膜成形术后提供辅助,适应症10.手术过程中产生脉动血流,禁忌症,1.严重的主动脉瓣关闭不全,2.,腹主动脉或主动脉有动脉瘤,3.,髂动脉严重钙化或外周血管疫病,4.,过度肥胖或腹股沟有瘢疤的病人不适合无鞘插入,禁忌症1.严重的主动脉瓣关闭不全,潜在的负面影响和并发症,下肢缺血,插入部位的出血,血小板减少,球囊导管无法打开,球囊泄漏,感染,股动脉撕裂,主动脉瘤,潜在的负面影响和并发症下肢缺血,Benchmark,SM,反搏结果统计,*,*,Results as of 1/2000,BenchmarkSM 反搏结果统计*Results a,Benchmark,SM,反搏结果统计*,*,Results as of 1/2000,BenchmarkSM 反搏结果统计*Results a,50,cc,40,34,25,cc,cc,cc,6 183 cms,54”-6 163-,183 cms,5-54”152-,163 cms,6 183 cms,