(主动脉内球囊反搏泵)IABP使用说明.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,前茂医疗器械（北京）有限公司,北京前茂公司地址,北京火车站,中粮广场,国际饭店,光华长,安大厦,东单路口,立交桥建国门,东长安街,N,地址：,北京市东城区建国门内大街7号,光华长安大厦,A,座1901-1902室,电话：,[phone],传真：,[phone],IABP,Intra-Aortic Balloon Pump,主动脉内球囊反搏泵,反,搏原理,内科适应症,内科适应症,不稳定心绞痛,心肌梗塞面积有扩大危险者,难治性室性心律失常,心源性休克,休克前状态,感染性休克,心脏挫伤,预防性支持,冠状动脉造影检查,PTCA,溶栓治疗,放置支架,瓣膜狭窄者,二尖瓣关闭不全,乳头肌断裂,室间隔缺损,室壁瘤,外科适应症,心脏手术术后低心排,脱机困难者（脱体外循环机）,预防性支持,非心脏手术,麻醉诱导期,绝对禁忌症,主动脉瓣关闭不全,主动脉夹层动脉瘤,相对禁忌症,终末期心肌病,严重动脉硬化,疾病终末期,腹主动脉瘤,IABP,机器,Arrow A,CAT,1 Plus,导管部分,穿刺部分,球囊,导管位置,接IABP,机器,左,锁骨下动脉,降,主动脉,肾,脏,放气,充气,阻断,主动脉,截面积：,85%,IAB,导管阻塞面积,EKG,充气,时机：在心脏舒张期,充气,益处,增加,冠脉血流,升高,舒张压力,增加,冠状动脉侧枝循环,增加,体循环灌注,放,气时机：在等容收缩期，主动脉瓣开放前瞬间,放,气益处,减少,后负荷,缩短,等容收缩期（,IVC）,增加,每搏量,增加,前向血流,临床表现,心肌,缺血症状减少,冠脉,血流增加,减少,后负荷,减少,心肌耗氧,充气,放气,临床,表现,增加,心输出量：,0.5 1 L/min,增加,尿量,减低,前负荷,减少,肺水肿,改善,精神状态,减,慢心率,减少,乳酸酸中毒,提高,脉率及脉压差,充气,放,气,怎样,才能正确调节充、放气时机,?,根据,动脉压力波形调节,动脉,压力波形图,PSP,舒张,期切迹（,DN）,PSP,舒张,期切迹（,DN）,AVO,AVO,AEDP,IVC,25%SV,75,%SV,X,X,APSP,舒张,期增压（,PDP,）,PSP,PAEDP,PAEDP,BAEDP,DN,70,90,110,70,55,80,反搏,搏动,辅助,后搏动,假设,：,BP=90/70,动脉,压力波形图,Without IABP,With IABP assist 1:2,Assist Ratios,1:1,1:2,1:4,PDP,应,大于,PSP,（PDPPSP）,除非,:,1.,病人,每搏量远远大于球囊容量,2.,导管,位置太低,3.,严重,低血容量,4.,球囊,充气量太小,5.,体,循环阻力太低,PSP,PSP,PDP,inflation,DN,比较充气时机和,DN,的位置,DN,DN,Just prior to DN,deflation,IAB,放气时图形与正常动脉波形比较,BAEDP PAEDP,APSP 40ms ,充气,过早,如果,可见,DN,充气,过晚,充放气,时机三步曲,放气,2.,BAEDP PAEDP,如果,BAEDP PAEDP,放气,过晚,3.,APSP PSP,如果,APSP=PSP,放,气过早,触发模式,规范型（,PATTERN,）,峰型（,PEAK,）,自动房颤（,AFIB,）,心室起搏触发（,V,PACE),）,心房起搏触发（,A,PACE,）,血压触,发（,AP,）,最低,3-5mmHg,触发,内触发（,INT,）,5,a.Trigger,Mode,Trigger Modes,ECG Pattern,This is a preset trigger mode,The computer analyzes the,height,width,(25-135,msec,),and,slope,of a positively or negatively deflected QRS complex.Rejection of pacer spikes are automatic.,Trigger Modes,ECG Peak,The computer analyzes the,height,and,slope,of a positively or negatively deflected QRS complex.This may be the trigger mode of choice for wide complex rhythms.Rejection of pacer spikes are automatic.,Trigger Modes,A-FIB,The computer analyzes the QRS complex in the same manner as peak mode.,Deflation is automatic,and occurs when the next,R-wave is sensed,.This allows for more consistent deflation timing when R to R intervals are very irregular.Rejection of pacer spikes is automatic.,Trigger Modes,VPace,The computer uses the,ventricular spike,as the trigger signal.This mode can be used with ventricular or AV paced rhythms.Must be,100%paced.,Trigger Modes,APace,The computer uses the,atrial,pacing spike,as the trigger signal.This mode can be used with,atrially,paced rhythms only.Must be,100%paced.,Trigger Modes,Arterial Pressure,The computer uses the,systolic upstroke,of an arterial pressure waveform as the trigger signal.This mode is an option when an ECG is unavailable or distorted.,Trigger Modes,Internal,The balloon inflates and deflates at a preset rate regardless of the patients cardiac activity.This mode is only to be used when there is no cardiac output and no ECG.,Preset rate is 80,.,May be varied,between 40 to 120bpm,.,护理项目,观察反搏效果,血流动力学状况，组织灌注情况，心脏缺血有无改善,观察有无并发症,肢体缺血，出血，感染，血栓形成，动脉损伤，,IABP,导管位置正确与否,IABP,工作情况,触发时机，触发模式，反搏比例,