改良房坦手术后右心房内球囊搏动辅助循环的实验研究

目的：为了提高改良房坦（Ｆｏｎｔａｎ）手术的早期生存率，我们研制了一种新型右心球囊辅助装置，通过机械辅助的方法帮助有房坦手术危险因素的患者。方法：该装置由标准的主动脉内球囊反搏机和一套并连的单球囊管和双球囊管组成，通过调节主动脉内球囊反搏机的充气时相，来驱动经外周静脉送入右心房和腔静脉内的球囊使之产生类似右心室收缩的效果，从而增加肺血流量。本实验比较了应用该装置在搏动频率１：１、１：２和停搏３种状态下对６条犬急性改良房坦模型的血液动力学的影响。各项指标由八导生理记录仪做同步记录，所有数据用配对ｔ检验做统计学分析。结果：研究发现，肺动脉血流量增加十分显著，当搏动频率为１：１和１：２时，分别比停搏时增加了８２％和６４％（Ｐ＜０．０５和Ｐ＜０．０１）。结论：可以认为新型辅助装置能有效地改善改良房坦手术后早期右心功能，这将为帮助有房坦手术危险因素的患者安全渡过围术期提供一种新的途径。

Experimental Study on Assisted Circulation by Right Atrial Balloon Pumping After Modified Fontan Operation

Objective:For increasing the early survival rate after modified Fontan operation,we designed a new right heart assisting device which can mechanically help the patients with high risk factors of Fontan.Methods:The system consisted of a standard IABP machine connected with a double-balloon catheter and a single-balloon catheter in parallel.By regulating the timing of inflation on IABP machine,the balloons inserted via a peripheral vein to the vena cava and right atrium pumped just like systole of the right ventricle so as to increase pulmonary blood flow. The hemodynamics of acute modified Fontan model in six dogs were compared under three pumping conditions,i.e. pumping ratio of 1: 1,1:2,and no pumping.All data were recorded synchronously in a 8-channel physiological recorder and analysed statistically by paired t test.Results:Pulmonary blood flow was very significantly augmented.With balloon ratio of 1:1 and 1:2, the pulmonary arterial blood flow was increased by 82% and 64%,respectively vs. that with no pumping(p<0.05 and p<0.01).Conclusion:The new balloon assisting device can effectively enhance early right heart function after modified Fontan operation and thus provides a new measure for the patients with high risk factors of Fontan to pass the perioperative period safely.