心室辅助

VentricularAssistDevicesReport:CRIJ心室辅助CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityPART1CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity目的心脏得以休息并恢复功能支持体/肺循环提供血流CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity目的PART2技术途径CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity左房或左室尖部引流血液至主动脉右房引流血液至肺动脉/主动脉CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity技术途径PART3装置构成CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity泵管道能量传输系统控制器导丝、鞘管等置入装置热交换器膜式氧合器氧混合器血滤装置CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity装置构成PART4分类CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity过度短期目的终末长期时间CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity分类CardiovascularDepartment,TheFirstHospitalofLanzhouUniversity分类恒流泵搏动LVADsRVADsBiVADs左室张力降低80%左右心肌耗氧降低40%左右以2.2L/(min·m2)开始CI2.5~4.2L/(min·m2)CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs最大限度的医疗支持1、完整和充分的心外科手术2、纠正所有代谢性问题3、使用了最大剂量的药物和IABP仍不能脱离体外循环4、心脏指数1.8~2L/(min·m2)CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs收缩压80mmHgLAP20mmHgSVR2100dyn·s/cm5尿量20ml/hCardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs患者是否有可能康复是决策是否应用LVADs的关键因素CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs必须考虑患者的年龄及一般医疗条件、有心事功能状况、心脏以外的器官功能（神经、肺、肾脏和肝脏）及其他医学问题（感染、血管病、糖尿病）。没有康复机会（过度、心脏移植、最终治疗）时是放置VAD的禁忌。CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs开机流量（L/(min·m2)）左房压（mmHg）CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs泵前性泵性泵后性血容量不足（α2）引流管位置不当/打折右心衰竭（β1）体循环压力高（α1、β2）管道打折产品质量问题CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs休息减少正性肌力药物CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs可否应用M受体激动剂或乙酰胆碱酯酶抑制剂？M2R（心脏）负性肌力负性频率负性传导Ach0.1~10mg/kg或毛果芸香碱0.1mg/kgCardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs48h后行TEE评估（预计短期支持者）停机过程中小剂量正性肌力药物支持每5min减小流量0.5L/min减至2L/min可准备停机随时准备送入手术室CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs70~75%心脏术后应用LVADs的患者，50%可撤除，25~30%存活出院CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityLVADs右心衰（RHF）RMI心肌保护欠佳肺血管阻力↑大量血制品多伴有LHF正性肌力药物IABPCardiovascularDepartment,TheFirstHospitalofLanzhouUniversityRVADs平均右房压20mmHgLAP15mmHg无三尖瓣反流CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityRVADs开机流量（L/(min·m2)）CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityRVADs泵前性泵性泵后性血容量不足（α2）引流管位置不当/管道打折肺循环压力高（PED抑制剂，NO，前列腺素类磺胺嘧啶苯）左心衰（正性肌力药、IABP）管道打折产品质量问题CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityRVADs评估、撤除同LVADs75%心脏术后应用RVADs的患者，35%可撤除，25%存活出院CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityRVADsLAP20mmHg右房压20~25mmHg无三尖瓣反流在右房压20mmHg时，不能维持LVAD流量2L/(min·m2)CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityBiVADs开机流量（L/(min·m2)）左房压（mmHg）右房压（mmHg）↑LVADsCardiovascularDepartment,TheFirstHospitalofLanzhouUniversityBiVADs评估、撤除同LVADs70%Cleveland统计数据30%存活出院CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityBiVADs没有康复机会时是放置VAD的禁忌CardiovascularDepartment,TheFirstHospitalofLanzhouUniversityVADsPART5各类VADsCardiovascularDepartment,TheFirstHospitalofLanzhouUniversityCardiacAssist,Inc://://://://://://://://://://®ABIOMED®Femoral/AxillaryArteryABIOMED://®PoweredbyACpowerInternalbatterypowerforatleast60minuteswhenfullychargedABIOMED®ControllerFirstheartassistdeviceapprovedbytheUSFDAPulsatilepumpABIOMED://://://://