肺动脉外气动隔膜反搏泵治疗右心衰竭的动物实验研究

发布时间：2018-03-09 08:50

本文选题：肺动脉外气动隔膜泵　切入点：心肌梗死　出处：《南华大学》2012年硕士论文　论文类型：学位论文

【摘要】：研究背景：心室辅助装置诞生以来，各国前辈们已取得不少成就。如：PABC、ECMO、Berlin heart心室辅助装置、离心泵、气动泵等。单独就右心辅助装置而言，临床主要应用在以下3个方面：①先天性畸形或后天病变的心脏加上手术创伤以及心肌缺血损害未能适应改变了的循环状态，手术后引起的泵衰竭导致肺循环高压及静脉系统的淤血；②左心辅助后心肌氧供失衡及左心辅助引起左右心室间的血流动力学紊乱，肺、脑、肾等重要器官功能障碍，从而导致右心衰竭加重，构成恶性循环；③阻力性肺动脉高压引起心肺移植前过渡期、各种器质性心脏病所引起的心源性休克。目前就单一右心辅助装置应用国内外较少见，本研究借鉴于PABC在肺动脉内通过反搏进行右心心室辅助的原理，在开胸手术中，利用肺动脉直接插管，连接本院自行研制的气动隔膜泵进行肺动脉外反搏，此技术能否达到辅助右心功能及在危重患者的泵衰竭、心源性休克及心脏术中血流动力学维持长效安全、简单有效的辅助循环稳定作用？目前国内外学术界研究较少，许多方面有待科学实验进一步证实。研究目的：探讨肺动脉外气动隔膜泵对右心心功能辅助治疗的可行性、有效性。研究方法： 12只犬，，一组为6只，共分成2组（空白对照组、肺动脉外气动隔膜泵辅助组），。均套扎右冠状动脉主干造成右室心肌梗死的动物实验模型共12例，监测梗死前、梗死后两组犬1-6小时内的心率、心排量、中心静脉压、心肌酶、血液形态学、心肌梗死区面积变化。结果：同等条件下，肺动脉外气动隔膜泵辅助组6只犬整体存活，死亡率为0%。空白对照组6只犬死亡半数计3只，死亡率为50%。肺动脉外气动隔膜泵辅助组对比空白对照组，辅助后的中心静脉压、心率、心指数、心输出量都更胜一筹。结论：肺动脉外气动隔膜泵反向搏动辅助右心功能效果确切，虽亦有损坏血液成分，但其能降低死亡率及中心静脉压，改善心指数，提高右心输出量。
[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.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R654.2;R-332

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