Name: the intra-aortic balloon pump
Uploaded: 2021-02-05T14:30:00
Description: Watch this Scientific Journal Video about The Intra-Aortic Balloon Pump at JoVE.com

该协议遵循机构人类研究伦理委员会的指导方针。
1. 插入前准备
注意：IABP最好在透视引导下插入心导管实验室。在非常危急的临床情况下，可以考虑床旁放置。
<ol><li>首先为手术准备导管实验室。准备无菌单和洗必泰或聚维酮碘，IABP控制单元，IABP导管，动脉通路超声，局部麻醉的1%利多卡因，微穿刺针和线，微穿刺鞘，IABP的7-8.5 F动脉通路鞘，具体取?...

<ol>
	<li>Hochman, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+revascularization+in+acute+myocardial+infarction+complicated+by+cardiogenic+shock.+SHOCK+Investigators.+Should+We+Emergently+Revascularize+Occluded+Coronaries+for+Cardiogenic+Shock.">Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock.</a> New England Journal of Medicine. 341 (9), 625-634 (1999).</li><li>Thiele, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraaortic+Balloon+Support+for+Myocardial+Infarction+with+Cardiogenic+Shock.">Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock.</a> New England Journal of Medicine. 367 (14), 1287-1296 (2012).</li><li>Berg, D. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+Shock+in+Contemporary+Cardiac+Intensive+Care+Units.">Epidemiology of Shock in Contemporary Cardiac Intensive Care Units.</a> Circulation Cardiovascular Quality and Outcomes. 12 (3), 005618 (2019).</li><li>Jeger, R. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ten-year+trends+in+the+incidence+and+treatment+of+cardiogenic+shock.">Ten-year trends in the incidence and treatment of cardiogenic shock.</a> Annals of Internal Medicine. 149 (9), 618-626 (2008).</li><li>Harken, D. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+surgical+treatment+of+acquired+valvular+disease.">The surgical treatment of acquired valvular disease.</a> Circulation. 18 (1), 1-6 (1958).</li><li>Moulopoulos, S. D., Topaz, S. R., Kolff, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extracorporeal+assistance+to+the+circulation+and+intraaortic+balloon+pumping.">Extracorporeal assistance to the circulation and intraaortic balloon pumping.</a> Transactions of the American Society for Artificial Internal Organs. 8, 85-89 (1962).</li><li>Kantrowitz, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Initial+clinical+experience+with+intraaortic+balloon+pumping+in+cardiogenic+shock.">Initial clinical experience with intraaortic balloon pumping in cardiogenic shock.</a> JAMA. 203 (2), 113-118 (1968).</li><li>Krishna, M., Zacharowski, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Principles+of+intra-aortic+balloon+pump+counterpulsation.">Principles of intra-aortic balloon pump counterpulsation.</a> Continuing Education in Anaesthesia Critical Care &amp; Pain. 9 (1), 24-28 (2009).</li><li>Mueller, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+intra-aortic+counterpulsation+on+cardiac+performance+and+metabolism+in+shock+associated+with+acute+myocardial+infarction.">The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction.</a> The Journal of clinical investigation. 50 (9), 1885-1900 (1971).</li><li>Kern, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Enhanced+coronary+blood+flow+velocity+during+intraaortic+balloon+counterpulsation+in+critically+ill+patients.">Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically ill patients.</a> Journal of American College of Cardiology. 21 (2), 359-368 (1993).</li><li>Patterson, T., Perera, D., Redwood, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-aortic+balloon+pump+for+high-risk+percutaneous+coronary+intervention.">Intra-aortic balloon pump for high-risk percutaneous coronary intervention.</a> Circulation: Cardiovascular Interventions. 7 (5), 712-720 (2014).</li><li>Parissis, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=IABP:+history-evolution-pathophysiology-indications:+what+we+need+to+know.">IABP: history-evolution-pathophysiology-indications: what we need to know.</a> Journal of Cardiothoracic Surgery. 11 (1), 122 (2016).</li><li>O'Gara, P. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ACCF/AHA+guideline+for+the+management+of+ST-elevation+myocardial+infarction:+executive+summary:+a+report+of+the+American+College+of+Cardiology+Foundation/American+Heart+Association+Task+Force+on+Practice+Guidelines.">ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.</a> Circulation. 127 (4), 529-555 (2013).</li><li>Ibanez, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2017+ESC+Guidelines+for+the+management+of+acute+myocardial+infarction+in+patients+presenting+with+ST-segment+elevation:+The+Task+Force+for+the+management+of+acute+myocardial+infarction+in+patients+presenting+with+ST-segment+elevation+of+the+European+Society+of+Cardiology+(ESC).">2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).</a> European Heart Journal. 39 (2), 119-177 (2018).</li><li>Santa-Cruz, R. A., Cohen, M. G., Ohman, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aortic+counterpulsation:+a+review+of+the+hemodynamic+effects+and+indications+for+use.">Aortic counterpulsation: a review of the hemodynamic effects and indications for use.</a> Catheterization and Cardiovascular Interventions. 67 (1), 68-77 (2006).</li><li>Hendrickx, H. H., Berkowitz, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differences+between+intra-aortic+balloon+pumps+and+their+use.">Differences between intra-aortic balloon pumps and their use.</a> Critical Care Medicine. 10 (11), 796-797 (1982).</li><li>Parissis, H., Soo, A., Leotsinidis, M., Dougenis, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+statistical+model+that+predicts+the+length+from+the+left+subclavian+artery+to+the+celiac+axis;+towards+accurate+intra+aortic+balloon+sizing.">A statistical model that predicts the length from the left subclavian artery to the celiac axis; towards accurate intra aortic balloon sizing.</a> Journal of Cardiothoracic Surgery. 6, 95 (2011).</li><li>Seldinger, S. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Catheter+Replacement+of+the+Needle+in+Percutaneous+Arteriography:+A+New+Technique.">Catheter Replacement of the Needle in Percutaneous Arteriography: A New Technique.</a> Circulation. 39 (5), 368-376 (1953).</li><li>Pucher, P. H., Cummings, I. G., Shipolini, A. R., McCormack, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+heparin+needed+for+patients+with+an+intra-aortic+balloon+pump.">Is heparin needed for patients with an intra-aortic balloon pump.</a> Interactive Cardiovascular and Thoracic Surgery. 15 (1), 136-139 (2012).</li><li>Collet, J. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2020+ESC+Guidelines+for+the+management+of+acute+coronary+syndromes+in+patients+presenting+without+persistent+ST-segment+elevation:+The+Task+Force+for+the+management+of+acute+coronary+syndromes+in+patients+presenting+without+persistent+ST-segment+elevation+of+the+European+Society+of+Cardiology+(ESC).">2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).</a> European Heart Journal. , (2020).</li><li>Thiele, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraaortic+Balloon+Pump+in+Cardiogenic+Shock+Complicating+Acute+Myocardial+Infarction.">Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction.</a> Circulation. 139 (3), 395-403 (2019).</li><li>Unverzagt, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-aortic+balloon+pump+counterpulsation+(IABP)+for+myocardial+infarction+complicated+by+cardiogenic+shock.">Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock.</a> Cochrane Database Systematic Review. (3), 007398 (2015).</li><li>Deppe, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preoperative+intra-aortic+balloon+pump+use+in+high-risk+patients+prior+to+coronary+artery+bypass+graft+surgery+decreases+the+risk+for+morbidity+and+mortality-A+meta-analysis+of+9,212+patients.">Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality-A meta-analysis of 9,212 patients.</a> Journal of Cardiac Surgery. 32 (3), 177-185 (2017).</li><li>Li, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+an+intra-aortic+balloon+pump+with+venoarterial+extracorporeal+membrane+oxygenation+on+mortality+of+patients+with+cardiogenic+shock:+a+systematic+review+and+meta-analysis.">Effect of an intra-aortic balloon pump with venoarterial extracorporeal membrane oxygenation on mortality of patients with cardiogenic shock: a systematic review and meta-analysis.</a> European Journal of Cardiothoracic Surgery. 55 (3), 395-404 (2019).</li><li>Wernly, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+circulatory+support+with+Impella+versus+intra-aortic+balloon+pump+or+medical+treatment+in+cardiogenic+shock-a+critical+appraisal+of+current+data.">Mechanical circulatory support with Impella versus intra-aortic balloon pump or medical treatment in cardiogenic shock-a critical appraisal of current data.</a> Clinical Research Cardiology. 108 (11), 1249-1257 (2019).</li><li>Seto, A. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+ultrasound+guidance+facilitates+femoral+arterial+access+and+reduces+vascular+complications:+FAUST+(Femoral+Arterial+Access+With+Ultrasound+Trial).">Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial).</a> JACC Cardiovascular Interventions. 3 (7), 751-758 (2010).</li><li>Erdogan, H. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+which+patients+should+sheathless+IABP+be+used?+An+analysis+of+vascular+complications+in+1211+cases.">In which patients should sheathless IABP be used? An analysis of vascular complications in 1211 cases.</a> Journal of Cardiac Surgery. 21 (4), 342-346 (2006).</li><li>Huckaby, L. V., Seese, L. M., Mathier, M. A., Hickey, G. W., Kilic, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-Aortic+Balloon+Pump+Bridging+to+Heart+Transplantation:+Impact+of+the+2018+Allocation+Change.">Intra-Aortic Balloon Pump Bridging to Heart Transplantation: Impact of the 2018 Allocation Change.</a> Circulation : Heart Failure. 13 (8), 006971 (2020).</li><li>Estep, J. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+placement+of+an+intra-aortic+balloon+pump+in+the+left+axillary/subclavian+position+provides+safe,+ambulatory+long-term+support+as+bridge+to+heart+transplantation.">Percutaneous placement of an intra-aortic balloon pump in the left axillary/subclavian position provides safe, ambulatory long-term support as bridge to heart transplantation.</a> JACC Heart Failure. 1 (5), 382-388 (2013).</li><li>Jeevanandam, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Hemodynamic+Effects+of+Intravascular+Ventricular+Assist+System+(iVAS)+in+Advanced+Heart+Failure+Patients+Awaiting+Heart+Transplant.">The Hemodynamic Effects of Intravascular Ventricular Assist System (iVAS) in Advanced Heart Failure Patients Awaiting Heart Transplant.</a> The Journal of Heart and Lung Transplantation. 36 (4), 194 (2017).</li><li>Siriwardena, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+intra-aortic+balloon+pump+use:+does+the+final+position+of+the+IABP+tip+matter.">Complications of intra-aortic balloon pump use: does the final position of the IABP tip matter.</a> Anesthesia Intensive Care. 43 (1), 66-73 (2015).</li><li>Maccioli, G. A., Lucas, W. J., Norfleet, E. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+intra-aortic+balloon+pump:+a+review.">The intra-aortic balloon pump: a review.</a> Journal of Cardiothoracic Anesthesia. 2 (3), 365-373 (1988).</li><li>The intra-aortic balloon pump: a review. Citoday Available from: <a target="_blank" href="https://citoday.com/device-guide/european/intra-aortic-balloon-pumps-1">https://citoday.com/device-guide/european/intra-aortic-balloon-pumps-1</a> (2020)</li></ol>

机械循环支持是一个快速发展的领域。即使有更新的支持设备的到来，IABP仍然是目前可用的25个使用最广泛和最简单的机械循环支持设备。在本文中，我们详细描述了经皮插入IABP的程序，适应症，证据，故障排除和并发症。尽管关于IABP在AMI相关心源性休克中的应用的证据相互矛盾，但它仍然是最广泛使用的机械支持形式。除了用于AMI相关的心源性休克外，IABP还用于冠状动脉搭?...

心源性休克是一种临床疾病，其特征是由于严重的心功能不全而导致终末器官灌注减少。最广泛接受的心源性休克定义是基于“我们是否应该紧急血运重建闭塞冠状动脉进行心源性休克”试验 （SHOCK）1 和主动脉内球囊支持心源性休克心肌梗死试验 （IABP-SHOCK-II） 试验2 ，包括以下参数：
1. 收缩压 <90 毫米汞柱 ≥30 分钟或血管加压药和/或机械支持以维持 SBP ≥90 毫米汞柱
2.终末器官灌注不足的证据（尿量<30mL/h或四肢发凉）
3. 血流动力学标准：心脏指数 ≤2.2 L/min/m2 和肺毛细血管楔压 ≥15 mm Hg
急性心肌梗死（AMI）是心源性休克的最常见原因，约占病例的30%。尽管AMI患者早期有创血运重建的治疗取得了进展，但心源性休克的死亡率仍然很高4。舒张期增大的机制显示冠状动脉灌注的改善和左心室功的减少，于1958年首次得到证实5。随后，在1962年开发了IABP的第一个实验原型6。六年后，Kantrowitz等人7首次 在四名AMI和心源性休克患者中使用IABP对药物治疗无反应。
IABP的作用机制涉及舒张期间气球的充气和收缩期的通气。这导致了两个重要的血流动力学后果：当球囊舒张膨胀时，主动脉中的血液向主动脉根部近端移动，从而增加冠状动脉血流量。当球囊收缩时放气时，它会引起真空或吸力效应，从而降低后负荷并增加心输出量8。IABP引起的血流动力学变化如下9 （表1）：
1.主动脉舒张压升高
2.收缩压降低
3.平均动脉压升高
4.肺毛细血管楔压降低
5.心输出量增加~20%
6.冠状动脉血流量增加10
IABP 的主要适应症是心源性休克（由于 AMI 和其他原因，如缺血性和非缺血性心肌病、心肌炎）、AMI 的机械并发症（如室间隔缺损或严重二尖瓣反流）、高风险经皮冠状动脉介入治疗期间的机械支持11、作为危重 CAD 患者冠状动脉搭桥手术的桥梁、无法停用体外循环以及作为决策或先进疗法的桥梁，如 终末期心力衰竭的左心室辅助装置（LVAD）或心脏移植12，13，14，15。使用IABP的禁忌症包括中度或重度主动脉瓣反流（可因反搏而恶化）、严重的外周血管疾病（会妨碍最佳的动脉通路和装置的放置）以及主动脉病变，如夹层12，15。
IABP装置由一个用于控制装置的控制台和一个带球囊的血管导管组成。
控制台包括以下四个组件：
a） 监测单元，有助于处理和确定气球的触发信号。信号可以是心电图（ECG）触发或压力信号触发;
b） 控制单元：处理触发信号并激活气阀以帮助充气或放气;
c） 含有氦气的气瓶。二氧化碳是一种替代品，但不如氦气优选。氦气密度较低，具有更好的气球充气特性，充气和通货紧缩速度更快16;
d） 有助于气体输送的阀单元。
IABP（球囊）导管是一种带有距离标记的 7-8.5 F 血管导管。导管的尖端安装有一个聚乙烯球囊。球囊尺寸可在 20-50 mL 之间变化。理想的球囊具有从左锁骨下动脉到乳糜泻动脉起飞的长度，膨胀的直径为降主动脉的90%至95%。成人患者最常用的球囊尺寸（身高 5'4“/162 cm 至 6'/182 cm）为 40 mL。50 mL球囊用于身高5'/182 cm>6'/182 cm的患者，34 cm球囊用于身高5'/152 cm至5'4“/162 cm的患者12，17 （表2）。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>IABP catheter and console</td>
			<td>Getinge</td>
			<td>Sensation Plus</td>
			<td></td>
		</tr>
		<tr>
			<td>Micropuncture Introducer Set</td>
			<td>Cook Medical</td>
			<td>G48006</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile drapes</td>
			<td>Haylard</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasound</td>
			<td>GE</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Lidocaine</td>
			<td>Pfizer</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

the intra-aortic balloon pump

心源性休克仍然是现代医学中最具挑战性的临床综合征之一。机械支持越来越多地用于心源性休克的管理。主动脉内球囊泵（IABP）是最早和最广泛使用的机械循环支持类型之一。该装置通过外部反搏起作用，并使用收缩压卸载和主动脉压舒张增强来改善血流动力学。尽管与较新的机械循环支持装置相比，IABP提供的血流动力学支持较少，但由于其插入和取出相对简单，需要更小尺寸的血管通路和更好的安全性，它仍然可以成为适当情况下的首选机械支持装置。在本综述中，我们讨论了IABP在心源性休克中的设备、程序和技术方面、血流动力学效应、适应症、证据、现状和最新进展。

尽管已经使用了几十年，但关于IABP使用的证据一直存在争议。不推荐 AMI 合并心源性休克患者常规使用 IABP。美国心脏协会/美国心脏病学会 （AHA/ACC） 和欧洲心脏病学会 （ESC） 之前的指南强烈建议在病理生理学考虑、非随机试验和注册数据的基础上，对 AMI 相关心源性休克患者（I B 类和 I C 类）使用 IABP。然而，AHA/ACC在2013年将IABP的使用降级为II类A，主要基于IABP Shock II试验的结果13<...

Watch this Scientific Journal Video about The Intra-Aortic Balloon Pump at JoVE.com

The Intra-Aortic Balloon Pump

我们描述了经皮植入主动脉内球囊泵（IABP），这是一种机械循环支持装置。它通过反搏起作用，舒张开始时充气，增加舒张主动脉压，改善冠状动脉血流量和全身灌注，并在收缩前放气，减少左心室后负荷。

主动脉内球囊泵

Cardiogenic shock remains one of the most challenging clinical syndromes in modern medicine. Mechanical support is being increasingly used in the ...

主动脉内球囊泵是一种支持装置，其工作原理是反搏动。它在舒张期充气，从而增加舒张主动脉压，改善冠状动脉血流量和全身灌注。并在收缩期间放气，从而减少左心室后负荷。今天演示球囊泵的插入，将是我和内布拉斯加大学医学中心介入心脏病学研究员Ganesh Gajanan博士。在进行手术之前，让患者平躺在仰卧位，并以通常的无菌方式准备和悬垂患者，并计划进入股动脉。接下来，使用50毫升注射器对IABP导管枢纽处的单向阀施加真空。当球囊完全放气后，取出导管中的探针，并用三到五毫升盐水手动冲洗内腔。对于 IABP 插入，使用 Seldinger 技术获得股动脉通路。使用超声引导的血管通路可提高首次通过的成功率并最大限度地减少血管并发症。以 45 度角插入微穿刺针。当观察到血液回流时，插入引入器线。在更换更大的IABP护套之前，先短暂插入微穿刺鞘。使用短行程，将 IABP 导管推进鞘，直到球囊尖端位于左锁骨下动脉起飞的远端。以气管隆突为标志，确保导管近端在肾动脉上方。然后将导管固定到位。固定导管后，取下导丝。用三到五毫升盐水冲洗内腔，并将一根标准动脉压监测管连接到导管枢纽。从导管上拆下单向阀，并使用提供的延长导管将导管枢纽连接到控制台。打开 IABP 并打开油箱。将心电图电缆和光纤或压力电缆连接到控制台。按主机上的开始键可自动清除、填充和校准气球。选择合适的心电图导联和触发，并设置充气和通货紧缩时间。根据临床情况选择合适的操作模式，选择触发源。IABP 使用触发器来识别下一个心动周期的开始，并在识别出触发事件时放气球。设置一到两个频率，并在IABP控制台上观察压力变化，以确认辅助收缩压低于无辅助收缩压，辅助压和舒张压降低，舒张压增大高于收缩压。如果已获得最佳 IABP 支持，请设置适当的 IABP 频率并确认 IABP 时间是否合适。然后设置导管，以每小时三毫升的速度通过内腔连续冲洗生理盐水。如果患者没有抗凝的临床禁忌证，则患者开始使用普通肝素或比伐卢定进行全身抗凝治疗，以降低动脉血栓栓塞的风险。检查患者的远端脉搏后，检查插入部位是否有出血或血肿的迹象，并监测尿量。重新检查球囊位置，确认球囊位于肾动脉水平上方。如果 IABP 管中有血液，则怀疑球囊破裂。然后进行胸部 X 线检查以验证设备的最佳定位，并更换无菌敷料以减少每天感染的机会。在移除 IABP 之前停止全身抗凝治疗，并将 IABP 设置为一对一。使用多普勒检查基线远端灌注和激活的凝血时间后，移除缝合线并在IABP控制台上按停止。拉动 IABP，直到遇到鞘上的阻力。将鞘作为一个单位握住IABP，并在股动脉上手动按压20至30分钟或直到出血停止。用多普勒重新评估远端脉搏。在该表中，可以观察到由IABP引起的血流动力学变化。如图所示，存在低于无辅助压力的辅助收缩压、辅助压和舒张压降低以及舒张压高于收缩压的舒张压增强，可以确认最佳的 IABP 支持。插入气球泵时要记住一些重要事项。确保球囊泵尽快插入护套。气球一旦脱离塑料保护膜，往往会迅速膨胀。球囊泵可以通过用电线向后加载或先连接到脉管系统，然后将球囊推进到电线上来插入。最后，确保球囊的尖端位于左锁骨下动脉起飞处，并且近端位于肾动脉上方。

Research

JoVE Journal

Medicine

Vascular Balloon Injury and Intraluminal Administration in Rat Carotid Artery

血管球囊损伤和腔内管理在大鼠颈动脉

The carotid artery balloon injury model in rats has been well established for over two decades. It remains an important method to study the molecular and ...

科研

医学

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

评价一种新型激光辅助冠状动脉吻合口连接器 - 三位一体夹 - 在猪非体外循环旁路模式

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the ...

A Rat Carotid Balloon Injury Model to Test Anti-vascular Remodeling Therapeutics

大鼠颈动脉球囊损伤模型试验抗血管重建治疗

The rat carotid balloon injury is a well-established surgical model that has been used to study arterial remodeling and vascular cell proliferation. It is ...

Fabrication of Small Caliber Stent-grafts Using Electrospinning and Balloon Expandable Bare Metal Stents

小口径支架移植物使用静电及球囊扩张裸金属支架的制作

Stent-grafts are widely used for the treatment of various conditions such as aortic lesions, aneurysms, emboli due to coronary intervention procedures and ...

Evaluation of Drug Sorption to PVC- and Non-PVC-based Tubes in Administration Sets Using a Pump

药物吸附的评价PVC-和非PVC为基础的管理管设置在使用泵

Administration sets are delivery tools for the direct application of drugs into the body and are composed of a spike, a drip chamber, tubes, Luer adapters ...

The Rabbit Model of Accelerated Atherosclerosis: A Methodological Perspective of the Iliac Artery Balloon Injury

家兔加速动脉粥样硬化模型的研究--髂动脉球囊损伤的方法学观察

Acute coronary syndrome resulting from coronary occlusion following atherosclerotic plaque development and rupture is the leading cause of death in the ...

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

球囊损伤诱发小鼠腹主动脉 Myointimal 增生的研究

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery

非体外循环冠状动脉旁路移植术治疗慢性心肌缺血的外科猪模型

Chronic cardiac ischemia that impairs cardiac function, but does not result in infarct, is termed hibernating myocardium (HM). A large clinical subset of ...

Harvest of Endothelial Cells from the Balloon Tips of Swan-Ganz Catheters after Right Heart Catheterization

右心导管插入术后天鹅管囊小贴中内皮细胞的提取

A variety of pathologies lead to pulmonary hypertension (PH), which is defined as a mean pulmonary artery pressure exceeding 25 mmHg at rest. To further ...

Implantation of an Isoproterenol Mini-Pump to Induce Heart Failure in Mice

植入异丙酮醇微型泵，以诱导小鼠心力衰竭

Isoproterenol (ISO), is a non-selective beta-adrenergic agonist, that is used widely to induce cardiac injury in mice. While the acute model mimics ...