双腔主动脉内气囊反搏的血流动力学影响的研究.docVIP

???? 双腔主动脉内?气囊反搏的血流动力学影响的研究? ???? ???? 摘　要：我们的实验结果表明双腔主动脉内气囊(DIAB)反搏的效果要优于单腔主动脉内气囊(SIAB)反搏的效果。它明显地改善血流动力学参数，进而提高了反搏的功效。也未发现双腔主动脉内气囊进行反搏会对肾脏的血流动力学参数产生不良影响。在对比肾动脉去神经前后主动脉内气囊反搏的结果，发现反搏时产生的脉动会对血管神经系统产生刺激，从而降低肾血管局部的阻力。这是当气囊进行反搏时，使肾脏血液循环得以改善的最重要因素。关键词：主动脉内气囊反搏(IABP)；冠状动脉；肾脏血流；神经活动分类号：R318.01; R318.1 STUDY ON THE HEMODYNAMIC EFFECTSOF DOUBLE CHAMBER INTRA-AORTIC BALLOON PUMPING Lu Songfang　Bao Yusheng　Pen Yi　Wang Chunren　Yu Xiaojun　Kong Hua　Xu Haiyan　Yang Zibin（Institute of Basic Medical Sciences, CAMS, School of Basic Medical Sciences, PUMC Beijing 100005） ABSTRACT：Our experimental results showed that the effects of double chamber intra-aortic balloon pumping (DIABP) were better than that of single chamber intra-aortic balloon pumping (SIABP) on the hemodynamics. The effects of double chamber intra-aortic blloon pumping (DIABP) on hemodynamic parameters in the kidney were also studied. Before and after removing the renal nerve system, the DIABP was used and the results were compared. The pulse produced by pumping activated the renal nervous system and reduced the renal vascular resistance. Therefore the reduction of the renal vascular resistance is an important reason for the increase the renal blood flow during intra-aortic balloon pumping. No negative effect of both cases was observed. DIABP significantly improved the hemodynamic parameters and increased the efficiency of the counterpulsation.Key words：Intra-aortic balloon pumping (IABP); Coronary artery; Renal blood flow; Nerve activity▲ 0　引言 　　主动脉内气囊反搏(IABP)作为一种心脏机械辅助的方法，用于心肌缺血性心脏病和心源性休克病人的抢救与改善危重病人血流动力学的疗效是非常显著的［1］。为提高和完善IABP方法，我们根据计算机优化和模拟实验的结果，研制了双腔主动脉内气囊(DIAB)［2］。在进行主动脉内气囊反搏时，由于气囊充排气的物理作用，气囊尾部将部分血液排向远心端，必然对肾脏产生一定的影响［3］，而DIAB进行反搏对冠状动脉的灌注量比用单腔主动脉内气囊(SIAB)增加了约25%［2］。由于气囊的容积是固定的，因此气囊尾部排向远心端的排出量将减少。为了评价使用DIAB进行反搏血流动力学影响以及阐明双腔主动脉内气囊反搏对肾脏影响的机制，我们分别使用DIAB和SIAB，在进行气囊反搏和不进行反搏的情况下测量了各项血流动力学参数，还比较了在未去神经与去神经后两种情况下，使用DIAB进行反搏对肾脏产生的影响。 1　方法 1.1　动物准备 　　20只实验用成年杂种狗，重25～30kg，雌雄不拘。皮下注射氯胺酮(ketamine, 200mg)，然后静脉注射戊巴比妥钠(pentobar