- 期刊
Hemodynamic Study of Left Ventricular Assist Device during Laparoscopy in Canine Model
腹腔鏡手術對左心室輔助器血液動力學影響之犬模式探討
摘要
為瞭解左心室輔助器使用中，同時進行腹腔鏡操作手術對心臟血管系統血液動力學的影響，以小型台大離心型葉輪式幫浦在6隻體重14-20kgs的健康犬隻進行動物模式檢測。實驗中針對大動脈、總頸動脈、冠狀動脈、股動脈和心室輔助器的血流進行收集，而動脈壓、幫浦血流壓力和心電圖也同時收集。當幫浦運轉中，心室輔助器可隨心臟收縮舒張週期產生一個上下起伏的血流波形，由於心室輔助器的主要血流導因於心臟收縮，故動脈血壓波形和總頸動脈、冠狀動脈、股動脈的血流在心臟收縮後會受到心室輔助器血流的輕微影響。在以腹腔充氣模擬腹腔鏡操作手術中，心室輔助器血流在4隻犬隻上升，另2隻血流則會下降，冠狀動脈血流在3隻犬隻會增加，1隻會下降，總頸動脈血流在2隻犬隻上升，另4隻則會下降，股動脈的血流在4隻中均會下降。但當提高幫浦轉速使心室輔助器的流量增加至高於50%總心輸出量時，可使幫浦流量與總心輸出量均增加，且受充氣影響的冠狀動脈與總頸動脈血流均會增加。此結果顯示：當腹腔鏡操作介入時，離心型葉輪式幫浦仍可安全的當作心室輔助器使用，且對心臟血管系統的血液動力學沒有明顯影響。
並列摘要
To understand the hemodynamic changes and interaction between the operation of left ventricular assist device (LVAD) and laparoscopy, a small Tai-Ta centrifugal impeller pump was applied in a canine model, in which 6 healthy dogs weighted 14-20kg were used. Blood flows in the aortic (AO) arch, common carotid artery (CCA), coronary artery (CA), femoral artery (FA), and the LVAD outlet were measured simultaneously with the arterial blood pressure (ABP), the pump outflow pressure (POP), and the electrocardiograph (ECG). After the centrifugal impeller pump operated, a fluctuated flow was produced by LVAD according to the cardiac cycles. The waveform of ABP and the flows of CA, CCA, and FA had mild change after systole due to the influence from LVAD flow. After abdominal insufflations the LVAD flow increased in 4 cases and decreased in another 2 cases, the CA flow increased in 3 cases and decreased in 1 case, the CCA flow increased in 2 cases and decreased in 4 cases, the FA flow decreased in all 4 cases. However, by increasing the rotational speed of pump to make LVAD flow more than 50% of total cardiac output, both the pump flow and total cardiac output increased, and the affected CA and CCA flows were also increased. These results indicated that the centrifugal impeller pump could safely operate as a LVAD without significant hemodynamic compromise when intervened with laparoscopy.
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