左心室辅助装置技术现状及未来展望

介绍了临床应用的左心室辅助装置的类型和结构特点,分析了基于生理机制的血泵电机参数的血泵控制策略;提出基于多生理信号约束的控制策略控制血泵输出,易满足受体的需求。结合血泵系统现状,从血泵的结构、穿皮能量传递方式和控制策略等方面探讨今后的研究目标。     

Cellular and segmental distribution of Ca2+-pump epitopes in rat intestine

We used a monoclonal antibody (5F10) specific for the human erythrocyte plasma membrane Ca⁺⁺-pump to demonstrate the presence and distribution of Ca⁺⁺-pump epitopes in rat intestine. In paraffin embedded tissue sections, antibody 5F10 binds to epitopes in the basolateral membranes of absorptive cells in rat duodenum and portions of jejunum but not ileum. Western blot analysis of intestinal mucosal proteins with antibody 5F10 shows binding of antibody to major bands of Mr 135,000 and Mr 72,000, and to lesser bands of Mr 125,000 and Mr 27,000. This pattern was seen in mucosal homogenates of rat duodenal and jejunal cells and to a lesser extent in ileal cells. The Mr 135,000 band corresponds to the molecular weight of Ca⁺⁺-pumps in other tissues. The other bands correspond in size to known proteolytic fragments of the Ca⁺⁺-pump. Slot-blot analysis of nitrocellulose immobilized mucosal homogenates shows binding of 5F10 to be greatest in duodenum and least in ileum. Ca⁺⁺- transport studies by the everted gut sac technique show a correlation between vitamin D induction of active Ca⁺⁺-transport and the segmental distribution of Ca⁺⁺-pump epitopes.     

Hyperpolarizing current of the Na/K ATPase contributes to the membrane polarization of the Purkinje cell in rat cerebellum

 The contribution of the Na/K ATPase (pump) current to the polarization of the Purkinje cell has been studied using slices of the rat cerebellum by blocking the pump with dihydro-ouabain (DHO) while recording the membrane potential with microelectrodes in the somata. From our recordings, it appeared that blocking the pump depolarized the Purkinje cells more rapidly than might be expected from shifts in Na⁺ and K⁺ concentrations, suggesting the removal of a hyperpolarizing current. Application of DHO, in the presence of tetrodotoxin (TTX), led to calcium spike firing and plateau-like discharges suggesting activation of voltage-dependent calcium channels in the dendrites. Adding 2 mM Co²⁺ to the medium did not prevent the depolarizations. Removing calcium from the bathing medium containing 2 mM Co²⁺ blocked the spiking activity but DHO application still produced a depolarization. Experiments to measure the current inhibited by DHO indicated that the Na/K pump supplies a constant current of 240 pA. Substitution of the sodium with choline produced a hyperpolarization, during which DHO had no effect on the membrane potential. Substitution of the sodium with lithium produced only a slowly developing depolarization. It is concluded that in the cerebellar Purkinje cell, a continuous sodium ion influx activates the pumps which produce a current that directly contributes to the membrane polarization. Possible pathways for this sodium influx are discussed. Received: 3 April 1997 / Received after revision and accepted: 12 May 1997     

Potassium induced potential changes in rat diaphragm muscle

Summary The effect of different potassium concentrations on the membrane potential and membrane resistance of rat diaphragm muscle fibres was measured by means of a double sucrose gap method and a microelectrode technique. Concentration measurements showed that the muscle fibres gained sodium and lost potassium in the equilibration period.In the absence of external chloride changing the external potassium concentration from 2.8 mM to potassium-free caused a depolarization of the membrane of about 30 mV and a small increase in membrane resistance.This K-dependent potential change (K-response) was reduced by ouabain, K-strophanthin, 2,4-dinitrophenol and cyanide, indicating that an energy requiring process is involved. The temperature dependence of the K-response found is consistent with this assumption. Variation in potassium permeability in the absence and presence of external potassium could account for only 13% of the K-response.The K-response amplitude appeared to depend on the external potassium and the internal sodium concentration. Hyperpolarization of the membrane could not only be produced after readmission of potassium but also after addition of thallium, the latter being more potent. Raising the external chloride concentration resulted in a decrease of the K-response and membrane resistance. The current, generating the Kresponse was shown to be hardly influenced by conditional polarization of the membrane.It is concluded from these results that the Kresponse is mainly due to the operation of an electrogenic sodium pump.     

Morphological inspection of 80 consecutive Gyro pumps after cardiopulmonary bypass

 We have been using the Gyro centrifugal pump C1E3 for cardiopulmonary bypass in anticipation of high efficiency, low hemolysis, and antithrombogenicity of this pump. However, the clinical evaluation of this pump remains to be clarified, because it has been a short time since the pump appeared in clinical situations. The aim of the present study is to inspect and analyze the Gyro pumps morphologically after clinical use. We examined 80 consecutive pumps after cardiopulmonary bypass for 186 ± 67 min with a mean flow rate of 2.52 ± 0.22 l/min/m² at a mean rotational speed of 2485 ± 81.1 rpm. Although no abnormal findings were present in 79 pumps, one pump was found to contain effusion at the connection between the impeller body and the shaft. The extudate was supposed to be blood, based upon the results of X-ray spectrometer analysis. The cause was determined to be the upward deviation of the shaft off the impeller body. Scanning electron microscopy showed scratches on a part of the bottom housing and a smooth surface of both the male and female pivots of the pump. Surface profile measurement revealed that the deformity of the female pivots was 0.14 mm (top) and 0.05 mm (bottom). These observations suggest that the floating force and vibration by the rotating impeller acted on the joint zone between the alumina ceramic shaft and the polycarbonate impeller body, resulting in dissection of the adhesive agent from the polycarbonate. Although this abnormality may be rare, the structural design still may need to be improved. Received: November 9, 2001 / Accepted: February 4, 2002     

采用永磁悬浮的永久性左心室辅助装置

研制出一台采用永磁轴承的左心室辅助装置（LVAD）。该装置包括一个定子和一个转子，采用径向驱动方式；转子包括驱动磁钢和叶轮，电机定子线圈和泵壳组成定子。装置设计采用了一种特殊结构的永磁轴承。转子的位置测量表明，转子稳定悬浮的前提条件是必须有较高的转速（大于3250r／min）且流量大于1L/min。用猪血为介质所做的液动力测试表明，当转速达到3500r／min～4000r／min时，血泵输出流量达到4L/min～6L/min，输出压力达到100mmHg。该装置重200g，最大处直径为40mm。     

In-vivo quantification of myocardial Na-K pump rate during β-adrenergic stimulation of intact pig hearts

Maintenance of adequate electrical activity of the heart depends critically on the ability of the Na-K pump to compensate for normal passive sodium and potassium fluxes. Using sudden injections of [³H]ouabain into the left coronary artery in anaesthetized open-chest pigs, we monitored transient changes in myocardial potassium balance by PVC-valinomycin mini-electrodes. When related to the number of pumps blocked and fractional inhibition, these data provided estimates of total Na-K pump capacity as well as actual pump rate and perturbations of the Na-K balance. Experiments were performed in hearts with and without intracoronary isoprenaline infusion (2.5 nmol min^-1). After injection of 120 nmol [³H]ouabain into the left coronary artery, myocardial [³H]ouabain concentrations were 118 (74–178) and 103 (76–145) pmol g^-1 and total concentrations of [³H]oubain binding sites were 893 (752–1076) and 785 (691–877) pmol g^-1 (median, 95% confidence interval) in isoprenaline-treated and control hearts respectively (differences not significant). The [³H]ouabain injection caused a net potassium release of 81 (56–132) and 43 (23–75) μcool 100 g^-1 (median, 95% confidence interval) in isoprenaline-treated and control hearts respectively (n= 6–8; significance of difference, P= 0.03). Na–K pump rate estimated from mono-exponential release curves was 6363 (3942–10,858) K⁺ ions min^-1 site^-1 during β-adrenoceptor stimulation and 2514 (1380–4322) in control (significance of difference, P= 0.03). This corresponds to 40 and 16%, respectively, of the maximum possible pump rate determined from ATP hydrolysis. Comparison of accumulated potassium release and relative Na-K pump rate indicates that catecholamines enhance the sensitivity of the Na-K pump for intracellular sodium.     

Influence of vascular parameters on the effectiveness of intra-aortic balloon pumping: A model study

The intra-aortic balloon pump has been widely used as a temporary heart-assist device. In this investigation, a nonlinear mathematical model of the arterial system and intra-aortic balloon pump was studied analytically. Thus, the influences of a number of vascular parameters on the effectiveness of intra-aortic balloon pumping (IABP) were determined. The effects of changes in vascular parameters of the model on a number of performance indexes were investigated. These performance indexes (aortic mean diastolic pressure, aortic end diastolic pressure, cardiac output, coronary flow and phase differences between the fundamental Fourier components of aortic root pressure and flow) were used as the criterion for an evaluation of the effectiveness of the assist pump. The following vascular parameters were perturbed by four steps (±10%, ±20%) from the values in the standard model: heart rate, peripheral resistance, left ventricular pressure, aortic elastance, aortic radius, arterial wall thickness, and aortic length. This model was evaluated for a wide range of balloon-pump phase-control settings (assisted case) and for the unassisted case (when the pump is disabled). It is concluded that changes in heart rate, peripheral resistance and left ventricular pressure cause the most significant changes in pump performance. Dr. Ohley is with the Datascope Corporation Dr. Kao is with the Technicare Corporation     

Relationship between chamber mechanical properties and mean pressure-mean flow diagram of the left ventricle

We undertook a theoretical analysis of the source resistance of the left ventricle represented in a mean pressure-mean flow diagram, using the chamber properties established in terms of the pressure-volume relationship. This analysis showed that pairs of points should lie above the linear function proposed by Elzinga and Westerhof. A third-order polynomial function would theoretically explain better than a linear relation or a parabolic fit the curved shape of experimentally obtained relationships. The analysis resolves the discrepancy between Elzinga and Westerhof's theoretical concept of linear source resistance and the actual nonlinear relationship.     

Relation between extracellular [K+], membrane potential and contraction in rat soleus muscle: modulation by the Na+-K+ pump

An increased extracellular K⁺ concentration ([K⁺]₀) is thought to cause muscle fatigue. We studied the effects of increasing [K⁺]₀ from 4 mM to 8–14 mM on tetanic contractions in isolated bundles of fibres and whole soleus muscles from the rat. Whereas there was little depression of force at a [K⁺]₀ of 8–9 mM, a further small increase in [K⁺]₀ to 11–14 mM resulted in a large reduction of force. Tetanus depression at 11 mM [K⁺]_o was increased when using weaker stimulation pulses and decreased with stronger pulses. Whereas the tetanic force/resting membrane potential (E _M) relation showed only moderate force depression with depolarization from –74 to –62 mV, a large reduction of force occurred whenE _M fell to –53 mV. The implications of these relations to fatigue are discussed. Partial inhibition of the Na⁺-K⁺ pump with ouabain (10^–6 M) caused additional force loss at 11 mM [K⁺]₀. Salbutamol, insulin, or calcitonin gene-related peptide all stimulated the Na⁺-K⁺ pump in muscles exposed to 11 mM [K⁺ ₀] and induced an average 26–33% recovery of tetanic force. When using stimulation pulses of 0.1 ms, instead of the standard 1.0-ms pulses, force recovery with these agents was 41–44% which was significantly greater (P < 0.025). Only salbutamol caused any recovery ofE _M (1.3 mV). The observations suggest that the increased Na⁺ concentration difference across the sarcolemma, following Na⁺-K⁺ pump stimulation, has an important role in restoring excitability and force.