辅以体外反搏的充气背心辅助循环术的血流动力学研究  

Hemodynamic Study of A New Assisted Circulation Method of Thoracic Pneumatic Vest with Enhanced External Counterpulsation

作　　者：袁衡新[1] 覃炳军[2] 张成喜[3] 蒋龙元[2] 孙俭[1] 袁志军[1] 黄源穗[1] 

机构地区：[1]中山大学中山医学院生物医学工程教研室,广东广州510080 [2]中山大学附属第二医院急诊科,广东广州510080 [3]中山大学附属第三院急诊科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2003年第2期121-125,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科委重点攻关基金资助项目(1995-1)

摘　　要：[目的]提出一种新型的无刨辅助循环方法,即辅以体外反搏的胸部充气背心辅助循环术(VEAC),并验证其血流动力学效果。[方法]用本室自行研制的多功能辅助循环装置,以R波触发,收缩期用胸部背心充气辅助心脏射血,舒张期配以增强型体外反搏改善心肌血供。8只犬普萘洛尔药物心衰模型,建模后30 min进行自身对照实验,观察血流动力学指标的变化。[结果]VEAC可显著增加心输出量[(0.82±0.25)L/min至(1.06±0.39)L/min,P<0.01]、左室压最大变化速率[(1 033±286)mmHg/s至(1 369±297)mmHg/s,P<0.05]、升主动脉收缩压峰值[(110±16)mmHg至(120±10)mmHg,P<0.05]、收缩压平均值[(99±19)mmHg至(106±17.)mmHg,P<0.05]、舒张压平均值[(89±20)mmHg至(98±18)mmHg,P<0.05]、冠脉有效灌注压[(86±20)mmHg至(93±19)mmHg,P<0.05]。[结论]实验结果表明VEAC具有胸部充气背心和增强型体外反搏的优点并且互补,同时增强心脏射血和改善心肌血供,可达到有效辅助循环的目的。[Objective] To research the hemodynamic effect of VEAC, Which is the combination of the thoracic pneumatic vest (VEST) synchronized with systole and the enhanced external counterpulsa-tion (EECP) during the diastole. It names as the VEST with EECP Assisted Circulation (VEAC) . [Method] Acute heart failure was induced by the propranolol hydrochloride in 8 adult mongrel dogs. Acute heart failure was verified by that the cardiac output decreased to 46. 51% [ (1. 53±0. 20) to 0. 82 ±0. 26) L/min, P < 0. 01] and maximum systolic dp/dt of left ventricle reduced to 45. 03% [ (1 879±504) to (1 033 ± 286) mmHg/s, P < 0. 01 ]. After 30 min of heart failure the VEAC were performed on each dog with the VEAC apparatus developed by ourselves. The hemodynamic parameters were measured by the polygraph. [Results] Compared with no assistance, VEAC significantly increased cardiac output [ (0. 82 ±0. 25) to (1. 06 ±0. 39) L/min, P < 0. 01], maximum systolic dp/dt of left ventricle[(1 033±286) to (1 369±297) mmHg/s, P < 0. 05], maximum systolic aorta pressure [(110±16)mmHg to (120 ±10)mmHg , P < 0. 05],mean systolic aorta pressure [(99±19)mmHg to (106±17 ) mmHg, P < 0. 05] , mean diastolic aorta pressure [ (89±20) mmHg to (98±18) mmHg, P < 0. 05] ,and coronary perfusion pressure[ (86±20)mmHg to (93 ±19)mmHg, P < 0. 05] respectively. [Conclusion] The results suggest that the VEAC have the advantage of both VEST and EECP, can assist cardiac ejection and enhance coronal perfusion at the same time.

关 键 词：辅助循环 心力衰竭 充血性 反搏动术 血液动力学 

分 类 号：R654.1[医药卫生—外科学] R318[医药卫生—临床医学]