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1、,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,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：（010）65101901 传真：（010）65102040,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
2、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 ACAT 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
3、缩期（IVC） 增加每搏量 增加前向血流,临床表现,临床表现,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,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.
4、 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,5a. Trigger Mode,Trigger Modes ECG Pattern,This is a preset
5、trigger modeThe 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 b
6、e 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 timin
7、g 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 paci
8、ng 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.,
9、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,
