CN109999315A - Percutaneous left heart drainage-tube - Google Patents
Percutaneous left heart drainage-tube Download PDFInfo
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- CN109999315A CN109999315A CN201910216001.2A CN201910216001A CN109999315A CN 109999315 A CN109999315 A CN 109999315A CN 201910216001 A CN201910216001 A CN 201910216001A CN 109999315 A CN109999315 A CN 109999315A
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- tube
- left heart
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0043—Catheters; Hollow probes characterised by structural features
- A61M25/0045—Catheters; Hollow probes characterised by structural features multi-layered, e.g. coated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
- A61M25/007—Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M2025/0008—Catheters; Hollow probes having visible markings on its surface, i.e. visible to the naked eye, for any purpose, e.g. insertion depth markers, rotational markers or identification of type
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0043—Catheters; Hollow probes characterised by structural features
- A61M25/0045—Catheters; Hollow probes characterised by structural features multi-layered, e.g. coated
- A61M2025/0046—Coatings for improving slidability
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biophysics (AREA)
- Pulmonology (AREA)
- Engineering & Computer Science (AREA)
- Anesthesiology (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Hematology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- External Artificial Organs (AREA)
Abstract
The invention discloses percutaneous left heart drainage-tubes comprising ventricle section in left ventricle and is located at endarterial artery segment (1) outside left ventricle, the angle between the ventricle section and artery segment (1) is 160 °~175 °；The ventricle section is made of suction casing (3) and non-suction casing (2), and the suction casing (3) is located at end, and multiple sucking side openings (4) are provided on the tube wall of the suction casing (3)；Plastics spring circle (7) are arranged with outside the non-suction casing (2) and artery segment (1)；The percutaneous left heart drainage-tube of the present invention can be placed in through axillary artery or arteria carotis, and operating process simplifies, and can cooperate with ventricular assist device, realize left heart venting.Drainage catheter is directly placed in left ventricle under cardiac ultrasonic or DSA guidance through peripheral blood vessel, does not need the high risks invasive operation such as atrial septal puncture or ventricle aperture；In addition this percutaneous left heart drainage-tube can the left room blood of effective drainage, ventricle load is reduced by this conduit in ventricle auxiliary.
Description
Technical field
The present invention relates to a kind of left heart drainage-tube, specifically a kind of percutaneous left heart drainage-tube belongs to medical device technology neck
Domain.
Background technique
Heart failure is global public health problem, and disease incidence is high, treats poor prognosis, disease financial burden weight.Entirely
- 65 years old 30 years old crowd disease incidence 1.5-2% of ball are greater than 65 years old crowd disease incidence 6-10%, and disease incidence is in lasting rising.The heart
Failure treatment includes drug therapy, following cardiac resynchronization therapy, heart transplant and mechanical-assisted circulation etc..Although the medicine of heart failure
Object treatment is continued to optimize, but research shows that 5 years overall survival rates are no more than 50%, and wherein the survival rate of terminal phase heart failure is more
It is low.
Ventricular assist device can be reduced cardiac work, provide circulatory support, and ventricular assist device is used from the 1960s
Since clinic, it is applied not only to the treatment of average of operation periods acute heart failure, it can also be used to transit to heart transplant treatment (bridge to
Transplant english abbreviation BTT) so as to improve the recovery of patients ' life quality, promotion heart function, survival rate is improved, at one
Divide and apply ventricular assist device in invertibity heart failure patient, Cardiac Function of Patients is likely to be obtained recovery.Ventricular assist device is pressed
It is divided into first generation pulsed ventricular assist device according to Blood pump type, gradually eliminates；Second generation axis stream and the centrifugal pump continuous type heart
Room auxiliary device is at present using most ventricular assist devices；Third generation magnetic suspension ventricular assist device, technical difficulty is high,
The expensive not yet larger scale clinical application of cost.
Ventricular assist device is divided into implantation auxiliary type and percutaneous auxiliary type according to whether implanting.Embedded type left ventricle is auxiliary
It helps device to need surgical operation, establishes left ventricle to aorta access under recycling in vitro, not all patient can be resistant to
It is performed the operation.If in addition some researches show that serious patients with cardiogenic shock to be implanted into long-term left ventricular assist device, postoperative death
Rate is higher.Percutaneous ventricle device can be placed quickly, to realize left room unloading, reduce left ventricular filling pressure and bulk of left ventricle, the increase heart
Output quantity, to restore the perfusion of vitals.
The intubation way and intubation type of percutaneous ventricular assist device have been largely fixed the clinical effect of ventricle auxiliary
Fruit, intubation speed, the incidence of complication, suitable environment etc..Traditional percutaneous ventricular assist device such as extracorporeal membrane oxygenation system
(extracorporeal membrane oxygenation, english abbreviation ECMO): passed through by a continuous blood flow centrifugal blood pump
The ductus venosus (15-29Fr) that femoral vein is built into extracts venous blood out, is led after the conjunction of membrane lung oxygen by the artery in femoral artery
It manages (15-23Fr) and oxygenated blood is injected into abdominal aorta.Disadvantage: this kind of intubation way causes the increase of left room afterload, results in
Left interior sludging, may cause left room end diastolic pressure (LVEDP), pulmonary capillary wedge pressure to patients with cardiogenic shock
(PCWP) reduction of increase and stroke output, has been further exacerbated by left ventricle congestive state, and have puncture cannula to point out
Blood risk, distal limb ischemic risk.
Intra-aortic balloon pump (Intra-aortic balloon pump, english abbreviation IABP) is by a 7.0-
The double channel catheter of 8.0Fr and a cylindrical polyethylene balloon form, and sacculus is set by conveying sheath through femoral artery or axillary artery
In in aorta, disadvantage: cannot obviously increase cardiac output, there is limb ischemia, vascular trauma, thrombosis, haemolysis, blood platelet
The potential risks such as reduction.
Impella is a kind of axis stream ventricular assist device being percutaneously placed in, and will be connected to pigtail by femoral artery puncture
The micro axial flow pump of catheter tip passes through aorta petal, and left room blood pump is become owner of intra-arterial to realize.Disadvantage: small axial flow pump
Very high revolving speed (33000-51000 revs/min) is needed to maintain flow, increases Blood damage risk, in addition the intubation way
It the complication such as fractures there are groin hemotoncus, conduit.
TandemHeart is a kind of external continuous flow centrifugation pump, drainage tube through femoral vein or jugular vein approach to right room,
21F conduit is placed in atrium sinistrum by atrial septal puncture.15-Fr is usually placed in femoral artery to 17Fr intrusion pipe.Disadvantage: entire
Implant surgery must carry out in conduit room；The size of casing is larger, and the limb ischemia of femoral artery distal end is a severe complication；
Atrial septal puncture increases iatrogenic injury.
Existing percutaneous ventricular assist device intubation is substantially placed by stock arteriovenous, and partial devices catheter tip is located in
In big blood vessel or left room, left room cannot be sufficiently drained, left room load is reduced.Such as the patent document of Publication No. CN104174078A
Disclosed auxiliary device belongs to first generation pulsed ventricular assist device through femoral artery merging left ventricular assist device, wherein needing
One-way valve controls blood flow direction, and thrombus and Blood damage risk are larger, and in addition femoral artery blood vessel is coarse, but pressure is higher, lead
Pipe periphery bleeding event is higher, and lethal accident will occur once conduit occur and slipping.Femoral artery puncture point to aorta and
Farther out, conduit will increase thrombosis risk across entire aorta, longer conduit to left room distance, in addition femoral artery to left room
Branch is more, and conduit placement difficulty is big, and catheter proximal end has damage the risk of other collateral blood vessels.
In conclusion how to design suitable intubation to realize quickly, effectively, safe auxiliary circulation is established, and simplifies behaviour
Make process, cooperate with ventricular assist device, realize left heart venting, it is urgently to be resolved as those skilled in the art to reduce ventricle load
Problem.
Summary of the invention
In view of the deficiencies of the prior art, to solve at least one above-mentioned technical problem, the present invention provides a kind of percutaneous left heart
Drainage tube, to realize quickly, effectively, safe auxiliary circulation is established, streamline operation, and collaboration ventricular assist device is realized left
Heart drainage, reduces ventricle load.
The technical solution that the present invention solves above-mentioned technical problem is:
Percutaneous left heart drainage-tube comprising ventricle section in left ventricle and be located at endarterial artery outside left ventricle
Section, the angle between the ventricle section and artery segment is 160 °~175 °；The ventricle section is made of suction casing and non-suction casing,
The suction casing is located at end, multiple sucking side openings is provided on the tube wall of the suction casing, for sucking the blood in left ventricle
Liquid；It is arranged with plastics spring circle outside the non-suction casing and artery segment, plays support fixed function.
In order to avoid the bicuspid valve in left ventricle, the suction casing is 1.5cm, and the non-suction casing is 3.5cm.
In isovolumic contraction period, when mitral valve closure when also not open aorta petal, the chambers of the heart is in " closing " state, a left side
Intra-ventricle cardiac pressure sharply increases, and occurring larger whole vortex in entire left ventricular cavity (can pass through VFM technology (Vector
Flow Mapping) observation), form is oval, and streamline is more loose, and in counterclockwise, blood flow is changed in apex steering
Towards left ventricular outflow tract；Penetrate the blood phase: integrally vortex disappears within the moment of opening of aortic valve, the left ventricle chambers of the heart, aorta
Left ventricular outflow tract view blood flow accelerates to flow into aorta with layer flow mode under valve, is originally located at the vortex of left ventricular cavity middle part and apex
It disappears, only under bicuspid valve valve and the visible lesser local eddy currents of left ventricular inflow tract, continues to penetrating when blood mid-term starts to disappear
It loses, the laminar flow blood flow signal ramped up from the apex of the heart to left ventricular outflow tract view is hereafter shown as in the left ventricle chambers of the heart, penetrating blood end
There is lesser vortex under aorta petal in phase；Isovolumic relaxation period: the moment before aortic valve closing, left into isovolumic relaxation period
Blood flow switchs to rapidly the low speed laminar flow towards the apex of the heart in the ventricle chambers of the heart, and velocity gradient is low compared with other cardiac phases；It is quickly full
Phase: atrium sinistrum blood flow enters left ventricle quickly through bicuspid valve with layer flow mode at this time, flows to left ventricle along left ventricular inflow tract
Apex；Slow filling period: the blood flow that phase of rapid filling enters in left ventricle turns to counterclockwise after reaching left ventricle apex, carries on the back
It from left ventricle apex, is flowed to left ventricular outflow tract direction, forms one with the blood flow in left ventricular inflow tract and be distributed in a left side
The whole vortex of the ventricle chambers of the heart；The left room systole phase: work as left atrium contracts, blood flow enters the left heart again with laminar flow in atrium sinistrum
Room is vortexed with the entirety of phase of rapid filling to continuity, and an inflow road and outflow is still presented in blood flow in the left ventricle chambers of the heart at this time
What road blood flow was collectively formed is distributed in the whole vortex of the entire chambers of the heart, and motion pattern is counter clockwise direction, and is continued to next aroused in interest
The isovolumic contraction period in period.
As shown in Figure 1, health adult's visible vortex below contraction early stage mitral valve leaflet.As left locular wall is shunk,
Left room cavity pressure increases, and left chamber blood flow beam is flowed out from left room basal part to aorta direction, and a part of blood flow beam is along two points
Valve flows out backwards, thus, an acceleration vortex is generated in the left chamber close to bicuspid valve ventricle surfaces.Shrinking advanced stage, base
This stream axis and interventricular septum in substantially parallel, velocity vector along left ventricular cavity close to nearly 3/4 area distribution of interventricular septum, direction
Aorta direction is directed toward by left ventricular apex section along basic flow direction.
Left ventricular outflow tract view and pipeline flow field are laminar flow under normal circumstances, there is vortex under mitral valve leaflet, enter if being vortexed
In lumen, vortex can generate disturbance in entire lumen.Meanwhile ventricular assist device provides biggish bear for drainage tube
Pressure, suction casing, which is located at vortex, can interfere pipeline lining stream, and the presence of negative pressure makes blood in the form of turbulent flow in pipeline in pipeline
Interior operation.The main reason for turbulent flow produces eddy stress in pipeline, it is higher than viscous stress more, is hematoclasis it
One.Moreover, turbulent flow generates unnecessary energy consumption, entire ventricle aided efficiency is reduced.The turbulent flow at drainage end continues to perfusion
End can generate shearing stress to blood vessel endothelium, damage blood vessel endothelium, make angionecrosis, calcification etc..
To solve the above-mentioned problems, it avoiding being vortexed the influence to drainage tube, suction casing needs to avoid left room inflow road, including
Bicuspid valve lower zone, therefore the optimal region of suction casing is interventricular septum to left ventricular outflow tract view region.Therefore, the ventricle section and
Angle between artery segment is 160 °~175 °, and such drainage tube is avoided being vortexed under bicuspid valve, avoid vortex to pipeline flow and
The influence of pipeline location.Under this above-mentioned angle, drainage tube, close to nearly 3/4 area distribution of interventricular septum, has been avoided close to left ventricular cavity
The left room inflow road of vortex, laminar flow environment are more advantageous to left room drainage.
In addition visible bicuspid valve and aorta petal in left chamber, wherein bicuspid valve valve body is longer, in the form of sheets film sample, is easy
It is inhaled into the sucking side opening of suction casing, inadequate drainage is caused and damages valve.The design of above-mentioned angle and length avoids two
Cusp does not hurt valve, not adherent.
The angle of ventricle section and artery segment is also conducive to simultaneously through the angle of truncus brachiocephalicus and the arch of aorta, aorta ascendens and a left side
The angle of chamber.In 160 °~175 ° angular ranges, suction casing can be allowed to avoid the possibility for being adsorbed onto mitral leaflet, and ensured
Suction casing is located at left room inflow road.
Traditional drainage pipe is thick silicone tube, and material is harder, position poor controllability, is more likely to damage ventricle because of misoperation
Wall, valve, chordae tendineae etc..The suction casing is connected with pigtail catheter (pigtail catheter), and pigtail catheter material is soft, ventricular organization
Damage risk is low, and convenient for positioning, after pigtail catheter is placed in ventricle, naturally tortuous distal end is in pigtail-shaped, avoids conductor housing and the heart
Room tissue directly contacts.
It in order to be positioned, is positioned especially for development, the ventricle section and artery segment junction are provided with metal and determine
Position ring.
The end of the artery segment is connected with reducer pipe, the external extracorporeal circulation set tube road of reducer pipe, reducer pipe, extracorporeal circulation set tube
Road and drainage tube constitute circulating line, realize blood circulation.
Positioning sheath (vagina vasorum) is provided with outside the artery segment, when being placed in pipeline, positioning sheath is connected with artificial blood vessel,
Closing, will not occur blood leakage.
Preferably, the gross area of multiple sucking side openings is greater than the area of section of artery segment or ventricle section.Poiseuille's law
Elaborate the rule that liquid flows in pipe-line system.Through Poiseuille's law it is found that under the identical situation of other factors,
Caliber is the key factor for determining blood flow is how many.The gross area of multiple sucking side openings is greater than the section face of artery segment or ventricle section
Product ensure that the maximum drainage flow of pipeline, enhance ventricle drainage effect.
This percutaneous left heart drainage-tube can be placed in through axillary artery or arteria carotis, and wherein axillary artery sets pipe row Minimally Invasive Surgery, and neck is dynamic
Arteries and veins sets pipe and passes through skin puncture.Either arteria carotis or axillary artery intubation can be placed quickly, by the experienced doctor of training
Teacher can successfully set pipe in 30 minutes, and operating process simplifies, and can cooperate with ventricular assist device, realize left heart venting.Drainage is led
Pipe is directly placed in left ventricle under cardiac ultrasonic or DSA guidance through peripheral blood vessel, does not need atrial septal puncture or ventricle is opened
The high risks invasive operation such as hole.In addition this percutaneous left heart drainage-tube can the left room blood of effective drainage, pass through in ventricle auxiliary
This conduit reduces ventricle load.
Detailed description of the invention
Fig. 1 is left ventricle schematic diagram.
Fig. 2 is drainage tube of the present invention (being free of plastics spring circle) schematic diagram.
Fig. 3 is drainage tube schematic diagram of the present invention.
Specific embodiment
The present invention will be further described in detail below with reference to the accompanying drawings and specific embodiments.
As shown in Figure 2,3, percutaneous left heart drainage-tube, using medical PVC or new polyurethane pipe, surface is coated with polyethylene pyrrole
Pyrrolidone (PVP) high-hydrophilic polymer coating significantly reduces coefficient of friction convenient for setting pipe comprising the heart in left ventricle
Room section and it is located at endarterial artery segment 1 outside left ventricle, the specification of the pipeline of ventricle section and artery segment 1 is 21Fr.The ventricle
Angle α between section and artery segment 1 is 165 ° (160 °~175 °), for the folder fixed between ventricle section and artery segment 1
Angle, the ventricle section and 1 junction of artery segment are provided with metal positioning ring, do not mark in figure.The setting of metal positioning ring can be with
By development (as irradiated by X-ray machine), to be positioned to pipeline.
The ventricle section is made of suction casing 3 and non-suction casing 2, and the suction casing 3 is located at end, and the suction casing 3 is
1.5cm, the non-suction casing 2 are 3.5cm, are provided with multiple sucking side openings 4, multiple suction sides on the tube wall of the suction casing 3
The gross area in hole 4 is greater than the area of section of artery segment 1 (or ventricle section).Suction casing 3 is connected with pigtail catheter 5.Non- suction casing 2
It is arranged with plastics spring circle 7 outside with artery segment 1, fixation is supported to pipeline.
The end of the artery segment 1 is connected with reducer pipe 6, and reducer pipe 6 is 3/8 inch, the external extracorporeal circulation set tube of reducer pipe 6
Road (for 3/8 inch), reducer pipe 6, extracorporal circulatory system pipeline and drainage tube constitute circulation line, realize blood circulation.The artery
Positioning sheath is provided with outside section 1, Fig. 2, is not marked in 3.Position sheath (also referred to as vagina vasorum), when be placed in pipeline, positioning sheath with manually
Blood vessel is connected, and blood leakage will not occur for closing.
The percutaneous left heart drainage-tube of the present invention is placed in through axillary artery or arteria carotis, and external reducer pipe 6, reducer pipe 6 can connect
Blood pump (setting is in vitro), blood pump passes through again in the artery of extracorporal circulatory system pipeline access human body.Blood pump is by the blood in left ventricle
It pumps out, is flowed into artery by drainage tube of the present invention, reducer pipe 6, effectively realize and drain left room blood, reduce ventricle load.
Above-described embodiment is not limit the invention in any way, all to be obtained by the way of equivalent substitution or equivalent transformation
Technical solution fall within the scope of protection of the present invention.
Claims (7)
1. percutaneous left heart drainage-tube, it is characterised in that including the ventricle section being located in left ventricle and be located at endarterial outside left ventricle
Artery segment (1), the angle between the ventricle section and artery segment (1) are 160 °~175 °；The ventricle section by suction casing (3) and
Non- suction casing (2) composition, the suction casing (3) are located at end, are provided with multiple sucking side openings on the tube wall of the suction casing (3)
(4)；Plastics spring circle (7) are arranged with outside the non-suction casing (2) and artery segment (1).
2. percutaneous left heart drainage-tube according to claim 1, it is characterised in that: the suction casing (3) is 1.5cm, described
Non- suction casing (2) is 3.5cm.
3. percutaneous left heart drainage-tube according to claim 1, it is characterised in that: the suction casing (3) is connected with pigtail
Conduit (5).
4. percutaneous left heart drainage-tube according to claim 1, it is characterised in that: the ventricle section and artery segment (1) connection
Place is provided with metal positioning ring.
5. percutaneous left heart drainage-tube according to claim 1, it is characterised in that: the end of the artery segment (1) is connected with
Reducer pipe (6).
6. percutaneous left heart drainage-tube according to claim 5, it is characterised in that: be provided with positioning outside the artery segment (1)
Sheath.
7. percutaneous left heart drainage-tube according to claim 1, it is characterised in that: the gross area of multiple suckings side opening (4) is big
In artery segment (1) or the area of section of ventricle section.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910216001.2A CN109999315A (en) | 2019-03-21 | 2019-03-21 | Percutaneous left heart drainage-tube |
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| CN112843463A (en) * | 2019-11-28 | 2021-05-28 | 丁海雁 | Artery blood circulation pipeline assembly and artificial artery blood extracorporeal circulation system |
| WO2021104449A1 (en) * | 2019-11-28 | 2021-06-03 | 业聚医疗器械(深圳)有限公司 | Arterial blood circulation duct assembly and artificial arterial blood extracorporeal circulation system |
| WO2023246277A1 (en) * | 2022-06-23 | 2023-12-28 | 上海焕擎医疗科技有限公司 | Ventricular assist apparatus and method for manufacturing same |
| CN117982225A (en) * | 2024-04-07 | 2024-05-07 | 柏意慧心(杭州)网络科技有限公司 | Method, device, equipment and medium for measuring geometric parameters of left ventricular outflow tract CSEPT |
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