本文選題：肺動(dòng)脈外氣動(dòng)隔膜泵　切入點(diǎn)：心肌梗死　出處：《南華大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景： 心室輔助裝置誕生以來(lái)，各國(guó)前輩們已取得不少成就。如：PABC、ECMO、Berlin heart心室輔助裝置、離心泵、氣動(dòng)泵等。單獨(dú)就右心輔助裝置而言，臨床主要應(yīng)用在以下3個(gè)方面：①先天性畸形或后天病變的心臟加上手術(shù)創(chuàng)傷以及心肌缺血損害未能適應(yīng)改變了的循環(huán)狀態(tài)，手術(shù)后引起的泵衰竭導(dǎo)致肺循環(huán)高壓及靜脈系統(tǒng)的淤血；②左心輔助后心肌氧供失衡及左心輔助引起左右心室間的血流動(dòng)力學(xué)紊亂，肺、腦、腎等重要器官功能障礙，從而導(dǎo)致右心衰竭加重，構(gòu)成惡性循環(huán)；③阻力性肺動(dòng)脈高壓引起心肺移植前過(guò)渡期、各種器質(zhì)性心臟病所引起的心源性休克。目前就單一右心輔助裝置應(yīng)用國(guó)內(nèi)外較少見(jiàn)，本研究借鑒于PABC在肺動(dòng)脈內(nèi)通過(guò)反搏進(jìn)行右心心室輔助的原理，在開(kāi)胸手術(shù)中，利用肺動(dòng)脈直接插管，連接本院自行研制的氣動(dòng)隔膜泵進(jìn)行肺動(dòng)脈外反搏，此技術(shù)能否達(dá)到輔助右心功能及在危重患者的泵衰竭、心源性休克及心臟術(shù)中血流動(dòng)力學(xué)維持長(zhǎng)效安全、簡(jiǎn)單有效的輔助循環(huán)穩(wěn)定作用？目前國(guó)內(nèi)外學(xué)術(shù)界研究較少，許多方面有待科學(xué)實(shí)驗(yàn)進(jìn)一步證實(shí)。 研究目的： 探討肺動(dòng)脈外氣動(dòng)隔膜泵對(duì)右心心功能輔助治療的可行性、有效性。 研究方法： 12只犬，，一組為6只，共分成2組（空白對(duì)照組、肺動(dòng)脈外氣動(dòng)隔膜泵輔助組），。均套扎右冠狀動(dòng)脈主干造成右室心肌梗死的動(dòng)物實(shí)驗(yàn)?zāi)Ｐ凸?2例，監(jiān)測(cè)梗死前、梗死后兩組犬1-6小時(shí)內(nèi)的心率、心排量、中心靜脈壓、心肌酶、血液形態(tài)學(xué)、心肌梗死區(qū)面積變化。 結(jié)果： 同等條件下，肺動(dòng)脈外氣動(dòng)隔膜泵輔助組6只犬整體存活，死亡率為0%�？瞻讓�(duì)照組6只犬死亡半數(shù)計(jì)3只，死亡率為50%。肺動(dòng)脈外氣動(dòng)隔膜泵輔助組對(duì)比空白對(duì)照組，輔助后的中心靜脈壓、心率、心指數(shù)、心輸出量都更勝一籌。 結(jié)論： 肺動(dòng)脈外氣動(dòng)隔膜泵反向搏動(dòng)輔助右心功能效果確切，雖亦有損壞血液成分，但其能降低死亡率及中心靜脈壓，改善心指數(shù)，提高右心輸出量。
[Abstract]:Background:. Since the birth of ventricular assistive devices, many of the world's predecessors have made many achievements. For example, the 10% PABCU ECMOBCU Berlin heart Ventricular Auxiliary device, centrifugal pump, Pneumatic pump, etc., as far as right heart assistive devices are concerned, Clinical application is mainly in the following three aspects: 1 congenital malformation or acquired disease of the heart plus surgical trauma and myocardial ischemia damage can not adapt to the changed circulation, Pump failure after operation leads to pulmonary circulatory hypertension and congestion of the venous system. (2) the imbalance of myocardial oxygen supply after the aid of the left heart and the disturbance of hemodynamics between the left and right ventricles as well as the dysfunction of the lung, brain, kidney and other important organs. As a result of the exacerbation of right heart failure, a vicious circle of resistance pulmonary hypertension causes cardiogenic shock caused by various organic heart diseases during the transition period before cardiopulmonary transplantation. At present, the use of single right heart assistive devices is rare at home and abroad. This study was based on the principle of right ventricular assist by counterpulsation in pulmonary artery by PABC. During thoracotomy, pulmonary artery direct intubation was used to connect the pneumatic diaphragm pump developed by our hospital to carry out external pulmonary artery counterpulsation. Can this technique be used to assist right heart function, pump failure in critically ill patients, cardiogenic shock and hemodynamics during cardiac surgery to maintain long-term safety, simple and effective auxiliary circulatory stabilization? At present, there is little academic research at home and abroad, many aspects need to be further confirmed by scientific experiments. Objectives of the study:. Objective: to investigate the feasibility and effectiveness of pneumatic diaphragm pump in the treatment of right heart function. Research methods:. Twelve dogs, 6 in one group, were divided into two groups (blank control group, external pneumatic diaphragm pump auxiliary group, 12 animal models of right ventricular myocardial infarction caused by ligation of right coronary artery trunk, and monitoring before infarction). Heart rate, cardiac output, central venous pressure, myocardial enzyme, blood morphology and myocardial infarction area were measured in the two groups within 1-6 hours after infarction. Results:. Under the same conditions, 6 dogs in the external pulmonary artery pneumatic diaphragm pump auxiliary group survived and the mortality rate was 0. The half death rate of 6 dogs in the blank control group was 3 and the mortality rate was 50. The pulmonary artery pneumatic diaphragm pump assistant group was compared with the blank control group. Central venous pressure, heart rate, cardiac index, and cardiac output were better after assistance. Conclusion:. The reverse pulsation of Pneumatic diaphragm pump was effective in assisting right cardiac function. Although it also damaged blood components, it could reduce mortality and central venous pressure, improve cardiac index and increase output of right heart.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R654.2;R-332

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