IAB临床应用.ppt

- * k * Arterial pressure waveform landmarks with 1:2 assist Patient Aortic End Diastolic Pressure (PAEDP), reflects lowest pressure in the aorta at the end of diastole, without IABP effect Peak Systolic Pressure (PSP), reflects LV work, the pressure the ventricle has generated, without IABP effect Peak Diastolic Pressure (PDP), reflects the increase in vascular pressure as a result of IAB inflation (also called augmentation) Balloon Aortic End Diastolic Pressure (BAEDP), reflects the decrease in vascular pressure prior to the next systole, caused by IAB deflation Assisted Peak Systolic Pressure (APSP), reflects the decrease in LV work as a result of decreased afterload Dicrotic Notch (DN), reflects closure of the aortic valve, the onset of diastole Rule 2 BAEDP is lower than the PAEDP, reflects that the balloon has deflated before the aortic valve opens Rule 3 APSP is lower than the PSP, reflects the reduction in LV work related to balloon deflation during the IVC phase, decreasing afterload - * k * 切迹点 平均压 收缩压 Pulse Pressure 舒张压 120 100 80 收缩期 舒张期 mm Hg 动脉压力波形 * * * 舒张期球囊增压 ? 冠脉灌注 有辅助的舒张末压 ? MVO2 需求 有辅助的收缩压 无辅助的收缩压 球囊开始充气 无辅助的舒张末压 140 120 100 80 60 mm Hg 在使用IABP时的动脉压力波形的改变 ? Datascope Corp. * APSP PDP PSP PAEDP BAEDP DN Patient Aortic End Diastolic Pressure 病患的主动脉 末期舒张压 Dicrotic Notch 重搏凹痕 Assisted Pesk Systolic Pressure 反搏辅助后 的收缩压 Peak Systolic Pressure 收缩压 Peak Diastolic Pressure 舒张压 Balloon Aortic End Diastolic Pressure 球囊在主动脉内 的末期舒张压 * 充放气时机的调整主要是观察机器以1:2比率反搏时的血压波形。1。PDP点是否高于PSP点10mmHg的压力值以上。（虚线①）2。PSP点是否略高于APSP点。（虚线②）3。PAEDP点是否略高于BAEDP点。（虚线③） PSP APSP BAEDP PAEDP PDP ① ② ③ * 此波谷由 充气键控制 此波谷由 放气键控制 PSP BAEDP APSP PAEDP PDP DN 观察充/放气时机位置 * 充气过早……每搏量减少；左心室容量（预加负荷）增大。 充气过晚……舒张压及冠脉灌注的增加不能达到最佳状态。 放气过早……后负荷及心脏做功减少不理想。 放气过晚……心脏做功增加；心输出量减少。 充放气时机错误 * 充气过早 PDP DN move inflation * 充气过晚 PDP DN move inflation * 放气过早 move deflation PSP APSP * 放气过晚 move deflation BAEDP PAEDP * 反搏频率 ? 1:1反搏 * 反搏频率 ? 1:2反搏 * ? 1:3反搏 反搏频率 * IABP使用注意事项 1 IAB球囊导管与泵连接