IABP资格培训

Intra-AorticBalloonCounterpulsationTherapy主动脉内球囊反搏治疗Caution:U.S.FederalLawrestrictsthisdevicetosalebyorontheorderofaphysician.Refertopackageinsertforcurrentindications,warnings,contraindications,precautionsandinstructionsforuse.NEWPOWERBEHINDAPROVENLEADERDATASCOPEISNOWMAQUET2nd–3rdICS5th–6thICSRightAtriumRightVentricleLeftAtriumLeftVentricleTricuspidValveMitralValve右心房左心房三尖瓣二尖瓣右心室左心室PHASESOFTHECARDIACCYCLE心脏循环阶段Systole:收缩期Diastole:舒张期VentricularFilling心室充盈AtrialSystole心房收缩IsovolumetricContraction等容收缩VentricularEjection心室射血IsovolumetricRelaxation等容舒张VentricularFilling心室充盈PHASESOFTHECARDIACCYCLE心脏周期时段心室充盈心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈心房收缩心室收缩心室舒张心电图心室压动脉压心房收缩等容收缩心室射血等容舒张心室充盈动脉压力波形主动脉瓣切迹收缩期舒张期动脉压力波形主动脉瓣切迹收缩期舒张期收缩期动脉压力波形主动脉瓣切迹收缩期收缩期舒张期舒张期动脉压力波形主动脉瓣切迹收缩期收缩期舒张期舒张期一个心脏周期DETERMINANTSOFMYOCARDIALOXYGENSUPPLYANDDEMANDCoronaryArteryAnatomy冠状动脉解剖DiastolicPressure舒张压DiastolicTime舒张期时间OxygenExtraction氧供Hemoglobin血红素PaO2动脉氧分压HeartRate心率Afterload后负荷Preload前负荷Contractility收缩力冠状动脉分支RightCoronaryArteryLeftMainCoronaryArtery冠状动脉分支右冠状动脉分支左冠状动脉分支CoronaryArteryAnatomy冠状动脉解剖学DETERMINANTSOFMYOCARDIALOXYGENSUPPLYANDDEMANDCoronaryArteryAnatomy冠状动脉解剖DiastolicPressure舒张压DiastolicTime舒张期时间OxygenExtraction氧供Hemoglobin血红素PaO2动脉氧分压HeartRate心率Afterload后负荷Preload前负荷Contractility收缩力冠状动脉血流右冠状动脉左冠状动脉舒张期收缩期DETERMINANTSOFMYOCARDIALOXYGENSUPPLYANDDEMANDCoronaryArteryAnatomy冠状动脉解剖DiastolicPressure舒张压DiastolicTime舒张期时间OxygenExtraction氧供Hemoglobin血红素PaO2动脉氧分压HeartRate心率Afterload后负荷Preload前负荷Contractility收缩力OXYGENEXTRACTION血红素DETERMINANTSOFMYOCARDIALOXYGENSUPPLYANDDEMANDCoronaryArteryAnatomy冠状动脉解剖DiastolicPressure舒张压DiastolicTime舒张期时间OxygenExtraction氧供Hemoglobin血红素PaO2动脉氧分压HeartRate心率Afterload后负荷Preload前负荷Contractility收缩力ClicktoPlayVideoHEARTRATE心率DiastolicPhase60bpmDiastolicPhase130bpmDIASTOLICPRESSUREANDDIASTOLICTIME舒张期压力和舒张期时间DETERMINANTSOFMYOCARDIALOXYGENSUPPLYANDDEMANDCoronaryArteryAnatomy冠状动脉解剖DiastolicPressure舒张压DiastolicTime舒张期时间OxygenExtraction氧供Hemoglobin血红素PaO2动脉氧分压HeartRate心率Afterload后负荷Preload前负荷Contractility收缩力AFTERLOAD后负荷右心房左心房右心室左心室DETERMINANTSOFMYOCARDIALOXYGENSUPPLYANDDEMANDCoronaryArteryAnatomy冠状动脉解剖DiastolicPressure舒张压DiastolicTime舒张期时间OxygenExtraction氧供Hemoglobin血红素PaO2动脉氧分压HeartRate心率Afterload后负荷Preload前负荷Contractility收缩力PRELOAD前负荷Astheend-diastolicvolumeincreases,sodoestheforceofventricularcontraction.Thusthestrokevolumebecomesgreateruptoacriticalpointafterwhichstrokevolumedecreases(cardiacfailure).由于舒张末期容积增加心室收缩力加强。因此，每搏输出量增大到一个临界点之后，每搏输出量减少（心脏衰竭）ReprintedwithpermissionfromPriceandWilson,PathophysiologyClinicalConceptsofDiseaseProcesses1978,McGraw-HillBookCompany.1002003004004080120160CardiacReserveCardiacFailureStrokeVolumemlEnd-DiastolicVolumeFRANKSTARLINGLAW每搏射血量DETERMINANTSOFMYOCARDIALOXYGENSUPPLYANDDEMANDCoronaryArteryAnatomy冠状动脉解剖DiastolicPressure舒张压DiastolicTime舒张期时间OxygenExtraction氧供Hemoglobin血红素PaO2动脉氧分压HeartRate心率Afterload后负荷Preload前负荷Contractility收缩力ClicktoPlayVideoCONTRACTILITY收缩性ReprintedwithpermissionfromPierceandWilson,Pathophysiology:ClinicalConceptsofDiseaseProcesses,1978,McGraw-HillCardiacIndex=CardiacOutputBSANormal=2.5-3.5l/min/m²Normal=4-6L/Min.CardiacOutput=HeartRatexStrokeVolumeMEASUREMENTOFCARDIACPERFORMANCE衡量心脏功能心输出量心率每搏输出量前负荷后负荷肌收缩力心输出量心率每搏输出量心指数体表面积SystemicVascularResistance=(MAP-MeanRA)x80全身血管阻力C.O.(NormalSVR=900-1500dynes/sec./cm-5)EjectionFraction=enddiastolicvolume–endsystolicvolume射血分数enddiastolicvolume(NormalEF=60-75%ofenddiastolicvolume)MEASUREMENTOFCARDIACPERFORMANCE衡量心脏功能LEFTVENTRICULARFAILURE左心衰LeftVentricularFailure左心衰血管收缩组织缺氧循环血容量过多Pumpingefficiency心脏泵血能力减小LVVolume&Pressure左心室容量和压力增加BaroreceptorsActivate压力感受器活性释放HR心率增加ReleaseofCatecholamines释放儿茶酚胺增加Afterload(SVR)后负荷增加O2Demand需氧量增加Preload(LVEDP)前负荷增加LeftVentricularFailureVasoconstriction左心衰血管收缩血管收缩C.O.GlomerularFiltrationPressureActivationofRenin-Angiotensin-肾素血管紧张素激活Aldosterone-ADH醛固酮-抗利尿素Na+&H2OReabsorption储留Preload(LVEDP)Afterload(SVR)O2DemandC.O.HRO2SupplyPulmonaryArteryPressureLeftVentricularFailureHypervolemia左心衰前负荷后负荷氧耗心排量心排量肺动脉压心率氧供肾小球过滤压压增加循环血容量过多PulmonaryEdemaOxygenationContractilityC.O.心排量BPAnaerobicMetabolismLacticAcidProductionTissueAcidosis组织酸中毒TissueAnoxia组织缺氧症DEATH死亡LeftVentricularFailureTissueHypoxia肺水肿氧供组织缺氧收缩力降低血压厌氧代谢乳酸产物组织缺氧LeftVentricularFailureThen血管收缩组织缺氧循环血容量过多考虑反搏干预治疗LeftVentricularFailureNow血管收缩组织缺氧循环血容量过多考虑反搏干预治疗THEMECHANICSOFBALLOONCOUNTERPULSATION主动脉内球囊反搏技术PRIMARYEFFECTSOFIABC首要影响球囊的因素供应增加需求减少IABINFLATION–DIASTOLE球囊充气–舒张Augmentationofdiastolicpressure增加心脏舒张期压力Increasecoronaryperfusion增加主动脉内灌注IncreaseMyocardialOxygenSupply增加心脏氧供IABDEFLATION–SYSTOLE球囊放气–收缩Decreaseafterload减少后负荷Decreasecardiacwork减少心脏做功Decrease