主动脉内气囊反搏用气囊与控制驱动系统

主动脉内气囊反搏（ＩＡＢＰ）是目前最常用的机械辅助循环方法之一，本文综述了目前主动脉内气囊反搏用气囊的类型和参数、反搏气囊控制系统和驱动系统的组成及工作原理，并介绍了主动脉内气囊反搏系统和技术的研究进展。     

冠状动脉狭窄时主动脉内气囊反搏对心内膜下动脉的影响

测量了左冠状动脉狭窄前后，主动脉内气囊反搏时，各项血流动力学参数，并用超声多普勒血流仪测量了室间隔动脉血流的变化。结果表明，当ＩＡＢＰ反搏时，加强了冠脉系统血流的脉动变化，在左冠状动脉主干狭窄时，对心内膜下小动脉的灌注产生不良影响。     

主动脉内气囊反搏驱动系统,气囊的现状及发展前景

主动脉内气囊反搏驱动系统、气囊的现状及发展前景中国医学科学院基础医学研究所包玉生综述杨子彬审作为药物无效的心肌梗塞及心脏术后重症心功能不全，低心排出量综合症治疗手段的主动脉内气囊反搏（ＩＡＢＰ），随着医用材料及医用仪器的发展，性能更稳定、安全、容易施...     

主动脉内气囊反搏并发症及预防

主动脉内气囊反搏并发症及预防中国医学科学院基础医学研究所包玉生综述杨子彬校主动脉内气囊反搏（ＩＡＢＰ）自１９６８年Ｋａｎｔｒｏｗｉｔｚ用于急性心肌梗塞合并心源性休克确认其效果以来，其适应症已扩大到心脏手术后休克，低心输出量综合症，特别是脱离体外循环困...     

冠脉搭桥术后应用IABP时冠脉近端血流速度的变化

目的：研究应用主动脉内球囊反搏泵（ＩＡＢＰ）对冠状动脉搭桥手术（ＣＡＢＧ）后冠状动脉近 端血流速度的影响。方法：对ＣＡＢＧ术后应用ＩＡＢＰ的１１例病人,经食道彩色多谱勒超声监测 ＣＡＢＧ术后应用ＩＡＢＰ在１：１气囊搏动情况下冠状动脉近端血流速度的情况,同时应用持续左心 功能监测仪（ＣＣＯ）观察血流动力学的变化。结果：ＩＡＢＰ明显增加冠状动脉血流均值和峰相血流 速度,舒张期流速和主动脉内平均流速于应用ＩＡＢＰ后明显加快（Ｐ＜０．０５）;ＣＣＯ结果显示心排量 （ＣＯ）和心脏指数（ＣＩ）于应用ＩＡＢＰ后即有增加的趋势,２小时明显恢复,４８小时已经恢复到术前 水平。结论：ＩＡＢＰ无可争议地增加了冠状动脉近端血流速度,使ＣＡＢＧ术后左心功能恢复加快。     

主动脉内气囊反搏在冠脉成形术中的应用

主动脉内气囊反搏在冠脉成形术中的应用中国医学科学院基础医学研究所包玉生综述杨子彬审虽然主动脉内气囊反搏（ＩＡＢＰ）能稳定心肌梗塞患者的血液动力学状态，患者的死亡率仍很高，对气囊依赖患者的死亡率几乎达１００％，因此对这类患者需要进行溶栓及经皮腔内冠状动...     

彩色多谱评价IABP对门静脉血流的影响

彩色多谱评价ＩＡＢＰ对门静脉血流的影响〔英〕／ＡＳＡＩＯ．－１９９３，３９．－１０３主动脉气囊反搏能增加近心器官的血流已被广泛认识，但描述ＩＡＢＰ对周边器官，如肾脏，肝脏的血流的影响的文献很少，作者应用彩色多谱勒对２３例心衰行间隔心跳ＩＡＢＰ的患者的...     

儿童用IABP导管的开发

儿童用ＩＡＢＰ导管的开发［日］／渡边弘…／／人工脏器．－１９９５，２４（２）．－２５１主动脉内气囊反搏（ＩＡＢＰ）由于简便有效，在成人中已广泛应用，但由于儿童主动脉的弹性大，不容易提高舒张压，气囊导管直径细，驱动抵抗大等而效果不佳，目前应用还没有普及...     

主动脉内气囊反搏用气囊与控制驱动系统

主动脉内气囊反搏是目前最常用的机械辅助方法之一，本文综述了目前主动脉内气囊反搏用气囊的类型和参数，反搏气囊控制系统和驱动第系统物组成及工作原理，并介绍了主动脉内气囊反搏系统和技术的研究进展。     

用模型分析心肌血流与阻力的灌注压依赖性

合理考虑心肌内有代表性的血管网，选用实测主动脉压和左心室腔压作为输入数据，建立了一种适于研究左心室壁心肌血流动力学机制的模型，能够同时仿真冠脉系统的动、静脉及微循环血流。在预测心肌灌注时相分布接近现有结论的基础上，研究了心肌血流与血管床阻力的灌注压依赖性。结论有助于理解主动脉内气囊反搏和体外反搏的治疗机制。     

Effects on the renal artery blood flow during the intra-aortic balloon pumping was used

INTRODUCTIONTheintra-aorticballoonpumping(IABP)isanimportantmethodtoassistthebeauintheclinic.ThismethodisspecialtogiveemergencytrCdrieflttOtheischemiccardiopathyandthecardiogenicshock,andtoimprovehemodynamiceffects.ThecuxativeeffectsofIABPareveryobviousll].Theaamalexperimelltwasdesignedtoexploretheeffectsoftheintra-aofticballoonontherenalemerybloodflowdchngpumping.MATERJALANDMETHODSaamalpreparationsfTwentyadultdogsofeithersexweighing15-20kgwereanesthetizedwithketalnine(200mgi.m…     

THE HEMODYNAMIC EFFECTS OF THE DOUBLE CHAMBER INTRA-AORTIC BALLOON PUMPING

1NTRODUCTIONItiswellknownthattheintra--aorticballoonpumping(IABP)isamechanicalassistantmethodofheart'ThecurativeeffectsofIABPareveryobvious'Itisspecialtogiveemergencytreatmenttotheischemiccardiopathyandthecardiogenicshock,andtoimprovehemodynamiceffectstl'Zi'InordertoraisethecurativeeffectsofIABPandperfectthistechnique,newattemptsareunceasinglyinprogressbymanyresearcherst3'4)'Accordingtotheresultofthecomputersimulation,anoptimizeddoublechamberintra--aorticballoon(DIAB)wasdesignedand…     

主动脉内气囊造型及控制的仿真研究

主动脉内气囊反搏(IABP)在临床中的应用非常广泛,是心血管病治疗的重要手段。我们利用心血管系统的计算机仿真模型,研究了主动脉内气囊的造型及控制参数对反搏效果的影响,并对上述参量进行了一系列优化,结论如下:无论双腔、三腔还是多腔气囊,尾囊的作用最为关键,如能保证其体积适当、直径略小于气囊的其他部分、且最早充气、最晚排气,得到的反搏效果将明显优于单囊反搏的情况。     

Influence of vascular parameters on the effectiveness of intra-aortic balloon pumping: A model study

The intra-aortic balloon pump has been widely used as a temporary heart-assist device. In this investigation, a nonlinear mathematical model of the arterial system and intra-aortic balloon pump was studied analytically. Thus, the influences of a number of vascular parameters on the effectiveness of intra-aortic balloon pumping (IABP) were determined. The effects of changes in vascular parameters of the model on a number of performance indexes were investigated. These performance indexes (aortic mean diastolic pressure, aortic end diastolic pressure, cardiac output, coronary flow and phase differences between the fundamental Fourier components of aortic root pressure and flow) were used as the criterion for an evaluation of the effectiveness of the assist pump. The following vascular parameters were perturbed by four steps (±10%, ±20%) from the values in the standard model: heart rate, peripheral resistance, left ventricular pressure, aortic elastance, aortic radius, arterial wall thickness, and aortic length. This model was evaluated for a wide range of balloon-pump phase-control settings (assisted case) and for the unassisted case (when the pump is disabled). It is concluded that changes in heart rate, peripheral resistance and left ventricular pressure cause the most significant changes in pump performance. Dr. Ohley is with the Datascope Corporation Dr. Kao is with the Technicare Corporation     

Left ventricular afterload and systemic hydraulic power during in-series cardiac assistance: Studies using intraaortic balloon pumping in dogs

The effects of in-series mechanical assistance on left ventricular (LV) afterload and aortic power dissipation were studied in four groups of open chest mongrel dogs: control, acute myocardial ischemia, cholinergic and beta-adrenergic blockade, and combined ischemia and blockade. Aortic root pressure, flow, power, and impedance and LV pressure and power were obtained. Assistance was provided by intraaortic balloon pumping. Times of inflation and deflation of the balloon were controlled to maintain a phase difference of 180° between the fundamental components of aortic root pressure and flow. Differences in hemodynamic parameters before and after 2–5 min of cardiac assistance were calculated. The results confirm other observations regarding effects of in-series assistance on LV and aortic pressure, cardiac output, and peripheral resistance. No consistent changes were obtained in the pulsatile components of aortic input impedance. A significant decrease (14–20%) was observed in the dc component of the impedance in all animals. The results reported here contradict previous reports regarding decreased LV power generation. It was found that LV power generation and aortic power dissipation increased significantly during assistance (LV, 3–17%; aortic, 4–19%). The results of this investigation also appear to conflict with previous reports regarding the role of cardiovascular control in “counteracting” the effects of assistance in the normal experimental preparation. They suggest that the short term effects are attributable directly to the device and are not mediated by the autonomic nervous system. This work was supported in part by SUPHS Grant HL-13737 to Sinai Hospital and by NSF Grant ENG 74-21085 to the University of Rhode Island. Portions of this investigation were performed while D. Jaron was Director of the Surgical Research Laboratory at Sinai Hospital of Detroit.     

Control of intraaortic balloon pumping: Theory and guidelines for clinical applications

The effectiveness of intraaortic balloon pumping was investigated by using a lumped parameter model of the cardiovascular/assist device system. The model consists of a time-varying elastance left ventricular simulation, a 2-element windkessel arterial simulation, and an RC venous return and pulmonary simulation. The four major hemodynamic variables, stroke volume (SV), aortic mean diastolic pressure (MDP), tension time index (TTI), and aortic end diastolic pressure (EDP), were divided into two categories related to system energy supply and demand: “external” and “internal” variables. The effects of balloon pumping on these variables can be described by closed-form equations that yield an optimal solution. The model prediction suggests that, in the ideal case, optimization of balloon pumping calls for instantaneous inflation of the balloon to maximum volume at end systole and instantaneous complete deflation at end diastole. For finite inflation/deflation rates, the optimal time for the start of inflation is end systole. Deflation timing, however, involves a tradeoff between maximizing the external variables and minimizing the internal variables. These predictions were tested using a nonlinear digital computer model. The results also suggest that when SV is not being monitored, optimal inflation timing can be controlled from the measurements of TTI or pulmonary venous pressure; optimal deflation timing can be controlled by a weighted combination of MDP and EDP.     

A study of optimal configuration and control of a multi-chamber balloon for intraaortic balloon pumping

Balloon configuration and control scheme are important for the optimization of assistance of the failing heart with an intraaortic balloon pumping device. In this work, the configuration of a multi-chamber balloon and control schemes have been investigated by using a hemodynamic model and computer simulation methods. Following the simulation study, physical testing and animal experiments were performed to demonstrate the simulation results. Results show that the optimal configuration and controlled multi-chamber balloon can provide better assistance to the failing heart. Based on the simulation and experimental results, it was found that the shape of the rear chamber of a multi-chamber balloon is critical. The optimal control scheme was to inflate the rear chamber first and deflate it last.     

孙氏手术治疗头臂血管严重受损的A型主动脉夹层过程中血液动力学参数的意义

目的:探讨孙氏手术治疗头臂血管严重受损的A型主动脉夹层对血液动力学参数的影响。方法:选取125例头臂血管严重受损的A型主动脉夹层患者,对其行孙氏手术,观察体外循环时间、主动脉阻断时间、低流量选择性脑灌时间以及同期合并手术;并发症及30 d内死亡发生率;手术前后左室舒张末期内径（LVEDD）、心指数（CI）、中心静脉压（CVP）。结果:患者体外循环时间、主动脉阻断时间以及低流量选择性脑灌时间平均分别为（194.32±52.64）、（103.66±33.07）、（23.15±7.29） min,同期合并手术主要有Bentall手术、升主动脉替换、主动脉瓣成形;19例（15.20%）发生并发症,主要有神经系统并发症、多脏器功能不全甚至衰竭、肾功能不全甚至衰竭,8例（6.40%）30 d内死亡,主要死于多脏器功能不全甚至衰竭;与手术前比较,手术后患者LVEDD显著降低,CVP、CI显著升高,差异有统计学意义（P<0.05）。结论:孙氏手术治疗头臂血管严重受损的A型主动脉夹层不仅能够降低并发症发生率和死亡率,而且还能改善血液动力学参数,对临床治疗A型主动脉夹层有积极意义。     

Hemodynamic similarities between the trigeminal and aortic vasodepressor responses

The hemodynamic changes associated with hypotension elicited by electrical stimulation of the spinal trigeminal complex (trigeminal depressor response, TDR) or the aortic nerve (aortic depressor reflex, ADR) were compared in rabbits anesthetized with urethan. The hypotension associated with each response was accompanied by bradycardia, a marked fall in total peripheral resistance, a small decrease in cardiac output, and a nonuniform decrease in regional vascular resistances, with the order of magnitude of the decrease being femoral greater than mesenteric greater than renal arterial resistance. In individual experiments the percent decrease in heart rate, total peripheral resistance, or regional resistances was plotted against the percent fall in arterial pressure to obtain a pair of regression lines during the TDR and ADR. There was no significant difference in the slope or y-intercept of the regression line between the TDR and ADR for all of the hemodynamic variables examined. In both responses, however, the slope of the femoral resistance/arterial pressure relationship was significantly greater than that of the renal resistance/arterial pressure relationship. We conclude that the TDR is characterized by a pattern of hemodynamic changes similar to that of the ADR.     

Increased reversal and oscillatory shear stress cause smooth muscle contraction-dependent changes in sheep aortic dynamics: role in aortic balloon pump circulatory support

Aims: The intra‐aortic balloon pumping (IABP) changes pressure and increases the aorta shear stress reversal (SS_R) and oscillatory (SS_O) components. Hence, IABP‐dependent changes in aortic biomechanics would be expected, because of vascular smooth muscle (VSM) tone (i.e. flow‐induced endothelium‐dependent response, related to SS_R and SS_O variations) and/or pressure changes. To characterize: (i) the IABP effects on the aortic and global (systemic circulation) biomechanics, analysing their dependence on pressure and VSM basic tone changes and (ii) the relation between the SS_R and SS_O and the aortic biomechanical changes associated with the VSM tone variations. Methods: Aortic flow, pressure and diameter were measured in eight sheep during basal, augmented and assisted beats (1 : 1 and 1 : 2 IABP modalities). Calculations: (i) aortic effective and isobaric elasticity, viscosity, circumferential stress, pulse wave velocity, shear stress and buffer and conduit functions, (ii) peripheral resistance, global compliance, reflection coefficient and wave propagation times and (iii) the relation between SS_R and SS_O and biomechanical changes associated with variations in the aortic VSM tone. Results: Augmented and assisted beats showed: global VSM relaxation pattern (reduced peripheral resistance and reflection coefficient; increased propagation times) and local VSM contraction pattern (increased viscosity; reduced diameter, elasticity and circumferential stress), associated with SS_R and SS_O, levels and changes. The vascular changes reduced the ventricle afterload determinants, increased the vascular buffer performance and kept the conduit capability. Conclusion: In addition to pressure‐dependent changes, IABP determined biomechanical changes related to variations in the VSM tone. The increased SS_R and SS_O were associated with the aortic VSM contraction pattern and biomechanical changes.