心室辅助装置治疗心力衰竭王生会议课件教学幻灯PPT文档资料.ppt
心脏辅助装置是将心脏内的一部分血液引流到辅助装置中,并通过VAD 提供的机械动力重新注入动脉,从而取代一部分心室的泵血功能。,心室辅助装置(Ventricular assist devices,VADs),心室辅助的目的,降低心脏负荷增加心肌氧供维持组织及器官的灌注,急性心梗后心源性休克的传统治疗,强心药（Inotrope）IABPOthers for acute coronary syndromes:ThrombolyticsEmergency PTCA/PCIEmergency CABG,住院死亡率高达 60%,心脏术后心源性休克,单中心(Hahnemann U.Hosp.,Philadelphia,PA)3000 例成年人心脏病手术经验住院死亡率与术后强心药（Inotrope）用量关系:No inotrope2%Low-dose inotrope4%Moderate-dose inotrope8%1-High-dose inotrope20%2-High-dose inotrope42%3-High-dose inotrope80%,Inotrope Score,Samuels et al,Ann Thorac Surg 2001;71:S67-72,Hospital Mortality,Inotrope Level,IABP Score,Parameters:Points:肾上腺素用量 0.5 mcg/kg/min2左房压 15 mmHg1尿量 100ml/hr 1SV02 60%1Range:0-5 points,Hausmann et al,Circulation 2002;106:I203-6,IABP Score,86%,57.5%,52.2%,30%,8.3%,0%,Hausmann et al,Circulation 2002;106:I203-6,0,1,2,3,4,5,Points,survival,Points,Bottom Line with Acute-CS,任何原因导致的致命性的心源性休克大剂量强心药无效单用IABP无法维持循环稳定Mechanical Support is AppropriateVAD,分 类,非搏动性体外装置：体外膜肺（ECMO）等搏动性体外装置：Abiomed BVS 5000等，用于左心辅助、右心辅助或双心辅助搏动性植入装置：Heartmate 等非搏动性植入装置：Impella LD等,临床应用,短期过渡支持：Abiomed BVS5000，AB5000，Impella LD等；移植前过渡：HeartMate LVAS(IP)气动搏动型泵，不需正规抗凝；Novacor LVAS,电动,正规抗凝 长期支持治疗：HeartMate VE等,ABIOMED循环支持系统,气动式搏动性 VAD单或双心室辅助根据前、后负荷自动调节异步每搏输出量7080 ml,最大流量为6 L/min;要求患者体表面积(BAS)大于1.3 m2一般辅助时间710 dBVS5000:第一个FDA批准用于治疗心脏外科术后 心衰的VAD,Circulatory Support System ABIOMED,System components:Atrial and arterial cannulaeSingle or Dual chambered blood pumpPneumatic drive console,Abiomed心室辅助产品,控制台,血泵,Abiomed BVS 5000,Pumping Chamber,Console,BVS Implants,Cumulative,BVS&AB5000 Apical“Sleeve”,Easy to put in,BVS&AB5000 Preservation of LV Apex,Easy to take out,AB5000 Registry Outcomes,86%,Post-CardiotomyCardiogenic Shock,Myocarditis,AMI(Heart Attack)Cardiogenic Shock,75%,67%,Survival,43%,57%,42%,%Recovery of the Survivors,*Represents all patients from all US AB5000 centers supported from Oct 2003 through June 2005,Real World:All US*Data,not selectedcenters or best practices,Impella LP 2.5 catheter.,Impella LD,当前最小的轴流泵，移动和携带方便 驱动装置30 cm 30 cm,重约3 kg轴叶轮直径6.4 mm,流量可达5 6 L/min左心辅助：通过主动脉瓣插入左心室完成泵血功能，最长辅助7 d右心辅助：插入右心房并通过一段PTFE人工管道(8 mm)与肺动脉连接 Impella LP 2.5可通过经皮股动脉穿剌完成,临床应用进展,高危患者OPCABG术中循环支持高危患者冠脉介入术中保护（LP2.5）,Acute Cardiogenic Shock Algorithm,Acute Cardiogenic Shock,Low Output 2 High Dose Inotropes,Inotropes,IABP,Precardiotomy,Postcardiotomy,Within 30min of 1st attempt to wean from CPB,Within 1 hour of 1st attempt to wean from CPB,IABP optional if condition warrants direct VAD insertion,check CVP and PAP check Echo,LVAD,RVAD,Bi-VAD,If RV fails after LVAD insertion,If LV fails after RVAD insertion,Samuels et al.Ann.Of Thorac.Surg 2001;71:S82-85,Within 6-24 hrs of MI,Within 1-6 hrs of MI,IMPELLA,BVS/AB5000,并发症,VAD 治疗总发生率高达67%,主要包括出血、右心衰竭、肾功能衰竭、感染、神经系统机械故障,展 望,微型微创、完全植入更少的血液接触面积更好的生物相容性高效能低损耗正确把握时机、合理运用设备,
