Teorie mimotělního oběhu
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Teorie mimotělního oběhu. Vratislav Fabián fabia v1 @ fel.cvut.cz Katedra fyziky Fakulta elektrotechnická ČVUT v Praze. Použití mimotělního oběhu. Při operacích srdce a plic Choroby chlopní Aneurysma Bypas Transplantace Nádory …. Funkce mimotělního oběhu. - PowerPoint PPT Presentation
Transcript of Teorie mimotělního oběhu
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Teorie mimotlnho obhu
Vratislav Fabin
Katedra fyzikyFakulta elektrotechnickVUT v Praze
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Pouit mimotlnho obhu
Pi operacch srdce a plic
Choroby chlopnAneurysmaBypas TransplantaceNdory
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Funkce mimotlnho obhunahrazuje po dobu vlastnho chirurgickho zkroku funkci srdce i plic
zajiuje tedy cirkulaci a okysliovn krve
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Princip mimotlnho obhuiln krev operovanho je odvdna jednou iln kanylou zprav sn nebo dvma kanylami zavedenmi do horn a doln dut lyokyslien krev je pivdna tepenn kanylou do aorty
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Historick vvojPrudk rozvoj po II. svtov vlce
1955 zaveden do klinick praxe v USA
1957-58 prvn pokusy o vyuit MO v SSR
70. lta 20. stol oxygentor z dutch vlken
1980 oxygentor Terumo
2005 JOSTRA HL30
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Ochrana myokarduperuena cirkulace v koronrnm eiti
kardioplegick roztok, 4C
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Krevn erpadla
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Krevn erpadlarotan vlekov pumpa
dva protilehl vleky (rolery) rotuj vpevn kleci resp. vlcov dutin a proti stnm tto klece resp. vlcov dutiny pesn definovanou silou komprimuj vloenou hadici, nejastji vyrobenou ze silikonovch materil, kterou protk krev.
linern
nen poteba stelirizace ped kadou operac
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Princip MO krevn erpadlakinetick centrifugln pumpa
vstupu krve axilnm otvorem do vlcov komory vn se nachz soustava nkolika vzjemn spojench rotujcch kuelovch ploch pohnnch elektromagnetem. Krev axiln vstupujc a nsledn dopadajc na tyto rotujc kuelov plochy je urychlovna a opout komoru tangenciln pi obvodu
je poteba sterilizovat ped kadou operac
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RezervorPro venzn krevNavazuje na nj oxygentor a pot vmnk teplaObjem a 2 litry
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Oxygentor
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Oxygentormembrnov oxygenace semipermeabiln membrna z celofnu (polypropylen)
shodn princip jako pi dialze
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Vmnk teplaudrovn poadovan teploty pacientatermoregulace v prbhu operace na MO
teplo je penen vodousoust oxygentoru
Pokles tlesn teploty o 10C
Snen metabolismu o 50%
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Vmnk tepla
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BSA Body Surface AreaMostellerova formule: BSA (m) = ( [h(cm) x m(kg) ]/ 3600 )
DuBois a DuBoisova formule:BSA (m) = 0.20247 x h(m)0.725 x m(kg)0.425
Haycockova formule:BSA (m) = 0.024265 x h(cm)0.3964 x m(kg)0.5378
Gehan a Georgova formule:BSA (m) = 0.0235 x h(cm)0.42246 x m(kg)0.51456
Boydova formule:BSA (m2) = 0.0003207 x h(cm)0.3 x m(g)(0.7285 - ( 0.0188 x LOG(g) )
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BSA Pkladh = 188 cm; m = 82 kg
Mostellerova formule:
BSA (m) = ( 188 x 82 / 3600 ) = 2,07
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Jostra HL20
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Jostra HL30
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Schma mimotlnho obhu
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Schma mimotlnho obhu
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SW JOCAP XL
Graf3
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as [min]
tlak [mm Hg]
teplota [C]
asov prbh tlaku (MAP) a teploty
Protokol
Tlakov protokol
Jmno:EvaDatum op.:07.08.2002Zatek op.:9:38:13
Pjmen:KrlovCelkov as op.:2:44:34Konec op.:12:22:47
Vsledky
Hodnota hran.tlaku HT [mmHg]:50.00Hodnota hran.teploty HTepl [C]:34.00Hodnota HT [mmHg] :50
Stedn hodnota MAP [mmHg]:78.00st pod hodn. HT a HTepl [min]:7.39Hodnota HTepl [C] :34
st pod hodnotou HT [%] :6.11st nad hodn. HT a HTepl [min]:157.17
st pod hodnotou HT [min] :10.04
Prm.tepl.pod/nad HT [C] :29.5631.12
Pozn.:
&L&8Fakultn nemocnice v MotoleKardiochirurgick oddlenV valu 84CZ - Praha 5
Protokol
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4735.150
7535.150
813550
843550
893550
913550
873550
863550
893550
1003550
983550
833550
8235.150
8835.150
6035.150
6335.150
5435.150
5735.250
5535.250
6135.350
7435.350
7135.350
7635.450
8135.450
8635.550
8635.550
8835.650
9035.650
7835.750
8335.750
6535.850
9335.850
8135.850
7635.950
8435.950
833650
923650
8436.150
7636.150
8036.250
8236.250
9136.350
9636.350
8636.350
8036.450
6236.450
6336.550
7136.550
7836.650
7736.650
7736.650
8236.650
8836.750
8436.750
8036.750
8136.850
8036.850
7536.850
7436.850
7736.850
8036.850
8136.950
8236.950
8136.950
8136.950
7636.950
7736.950
743750
773750
793750
7937.150
8037.150
7937.250
7837.250
7937.350
7937.350
8137.350
7737.450
7037.450
7537.550
8037.550
8037.650
7337.650
7937.650
8137.650
6937.750
6637.750
7037.750
7737.750
8337.750
8437.750
7437.750
5237.750
5137.650
5437.650
5537.650
5837.650
5837.550
6137.550
6037.450
6337.450
6537.450
6437.350
6437.350
6737.250
7137.250
7437.250
7237.150
7437.150
813750
773750
783750
7536.950
7736.950
7336.950
7136.850
6936.850
6836.750
6736.750
6536.750
6636.650
6836.650
6736.650
6636.550
6636.550
6636.550
6736.450
6736.450
6636.450
6636.450
6636.350
6736.350
6836.350
6836.350
&A
Page &P
as [min]
tlak [mm Hg]
teplota [C]
asov prbh tlaku (MAP) a teploty
List4
4.07
4.16
4.39
4.59
4.68
4.77
4.89
5.11
5.25
5.71
6.11
6.41
6.96
7.31
7.61
8.24
8.94
9.64
10.28
11.03
11.3
11.96
12.69
13.39
14.22
14.93
16.19
17.65
19.11
19.89
20.74
21.84
23.43
25.86
28.06
30.09
32.15
34.47
37.28
40.69
44.25
48.53
52.09
55.61
58.87
61.35
64.46
68.81
73.81
77.78
81.06
83.95
86.25
88.01
90.24
92.38
94.43
96.46
97.29
98.35
98.82
HT [mm Hg]
st pod hodnotou HT [%]
asov sek v % pod hodnotou hraninho tlaku RT
6935.6000404.076.690505034035.60
7135.60.257537819500414.166.84050035.60
7135.60.51507563900424.397.2105009:38:1307.08.200209:38:1307.08.2002035.60
7235.60.772613458500434.597.5505012:22:4707.08.200212:22:47035.60
7435.61.03015127800444.687.690502:44:34035.60
7335.61.287689097500454.777.84050035.60
7535.61.545226917100464.898.0305009122035.60
7835.51.802764736600475.118.4050382244035.50
7935.52.060302556100485.258.63050134734035.50
7935.52.317840375600495.719.380500.2575378195035.50
8135.52.575378195100506.1110.04050KrlovEva035.50
8135.52.832916014600516.4110.53050035.50
8135.53.090453834100526.9611.44050035.50
8335.53.347991653600537.3112.01050035.50
8335.53.605529473100547.6112.5050035.50
8035.53.863067292600558.2413.53050035.50
7835.54.120605112200568.9414.7050035.50
8135.54.378142931700579.6415.84050035.50
7835.54.6356807512005810.2816.9050035.50
7535.54.8932185707005911.0318.12050035.50
7735.55.1507563902006011.318.57050035.50
8135.55.4082942097006111.9619.66050035.50
8135.55.6658320292006212.6920.85050035.50
7735.55.9233698487006313.3922050035.50
8035.56.1809076682006414.2223.37050035.50
7835.56.4384454877006514.9324.54050035.50
8035.56.6959833073006616.1926.61050035.50
8235.56.9535211268006717.6529.01050035.50
8235.57.2110589463006819.1131.41050035.50
8035.57.4685967658006919.8932.68050035.50
8335.57.7261345853007020.7434.08050035.50
8435.57.9836724048007121.8435.88050035.50
8335.58.2412102243007223.4338.5050035.50
7235.58.4987480438007325.8642.5050035.50
8035.58.7562858633007428.0646.1050035.50
8735.59.0138236828007530.0949.43050035.50
8835.59.2713615023007632.1552.83050035.50
9135.59.5288993219007734.4756.63050035.50
9035.59.7864371414007837.2861.25050035.50
9235.510.0439749609007940.6966.86050035.50
9735.510.3015127804008044.2572.71050035.50
9735.510.5590505999008148.5379.73050035.50
9735.510.8165884194008252.0985.58050035.50
9735.511.0741262389008355.6191.37050035.50
9635.511.3316640584008458.8796.73050035.50
9635.511.5892018779008561.35100.81050035.50
10035.511.8467396974008664.46105.91050035.50
9335.512.104277517008768.81113.05050035.50
9935.512.3618153365008873.81121.28050035.50
10035.512.619353156008977.78127.8050035.50
11335.512.8768909755009081.06133.19050035.50
9135.313.134428795009183.95137.94050035.30
6134.913.3919666145009286.25141.72050034.90
5334.713.64950443400.259388.01144.61050034.70
4934.513.9070422535119490.24148.2805034.500
4834.314.164580073119592.38151.7905034.300
4934.214.4221178925119694.43155.1605034.200
5034.214.6796557121009796.46158.49050034.20
5234.114.9371935316009897.29159.86050034.10
5534.115.1947313511009998.35161.6050034.10
5734.115.45226917060010098.82162.36050034.10
5934.115.709806990100050034.10
5834.115.967344809600050034.10
5534.116.224882629100050034.10
553416.4824204486001500340
563416.7399582681001500340
573416.9974960876001500340
593417.2550339071001500340
583417.512571726700.11111111111500340.1111111111
493417.770109546210.33333333331503400.3333333333
523418.0276473657001500340
583418.2851851852001500340
613418.5427230047001500340
633418.8002608242001500340
643419.0577986437001500340
633419.3153364632001500340
613419.5728742827001500340
653419.8304121022001500340
643420.0879499218001500340
603420.3454877413001500340
623420.6030255608001500340
623420.8605633803001500340
693421.1181011998001500340
713421.3756390193001500340
743421.6331768388001500340
733421.8907146583001500340
723422.1482524778001500340
733422.4057902973001500340
7533.922.663328116800150033.90
7833.922.920865936400150033.90
7033.923.178403755900150033.90
7233.923.435941575400150033.90
6033.923.693479394900150033.90
5133.923.951017214400150033.90
5633.824.208555033900150033.80
6433.824.466092853400150033.80
6833.724.723630672900150033.70
6833.724.981168492400150033.70
7133.725.238706311900150033.70
7333.725.496244131500150033.70
7333.725.75378195100150033.70
7133.626.011319770500150033.60
7333.626.2688575900150033.60
7533.626.526395409500150033.60
7433.626.78393322900150033.60
7333.627.041471048500150033.60
7933.627.29900886800150033.60
7033.627.556546687500150033.60
6733.627.81408450700150033.60
7133.628.071622326600150033.60
7633.528.329160146100150033.50
7433.228.586697965600150033.20
7832.928.844235785100150032.90
8732.629.101773604600.1590909091150032.60.1590909091
4332.229.35931142411115032.201
3431.829.616849243610.761904761915031.800.7619047619
5531.629.874387063100150031.60
7531.330.131924882600150031.30
6831.130.389462702100.1428571429150031.10.1428571429
4730.830.647000521610.0937515030.800.09375
7930.530.904538341200150030.50
7430.231.162076160700150030.20
663031.4196139802001500300
7929.631.677151799700150029.60
7929.431.934689619200150029.40
7329.132.192227438700150029.10
7528.932.449765258200150028.90
8128.732.707303077700150028.70
8428.632.964840897200150028.60
9128.333.222378716700150028.30
9128.133.479916536300150028.10
9127.933.737454355800150027.90
9127.733.994992175300150027.70
9027.534.252529994800150027.50
8827.334.510067814300150027.30
8627.134.767605633800150027.10
7227.135.025143453300150027.10
7227.135.282681272800150027.10
7627.135.540219092300150027.10
7627.135.797756911800150027.10
732736.0552947314001500270
8227.136.312832550900150027.10
8127.136.570370370400150027.10
8027.136.827908189900150027.10
7727.137.085446009400150027.10
6927.137.342983828900150027.10
7327.137.600521648400150027.10
7327.137.858059467900150027.10
7727.138.115597287400150027.10
7927.238.373135106900150027.20
8027.238.630672926400150027.20
8227.238.88821074600150027.20
8727.239.145748565500150027.20
8427.239.40328638500150027.20
8727.339.660824204500150027.30
8627.339.91836202400150027.30
8727.340.175899843500150027.30
8827.340.43343766300150027.30
8927.340.690975482500150027.30
9227.340.94851330200150027.30
9227.241.206051121500150027.20
9427.241.463588941100150027.20
9127.241.721126760600150027.20
9427.241.978664580100150027.20
8727.242.236202399600150027.20
8027.242.493740219100150027.20
8627.142.751278038600150027.10
9227.143.008815858100150027.10
9027.143.266353677600150027.10
8827.143.523891497100150027.10
8927.143.781429316600150027.10
9127.144.038967136200150027.10
9127.144.296504955700150027.10
852744.5540427752001500270
902744.8115805947001500270
872745.0691184142001500270
722745.3266562337001500270
752745.5841940532001500270
762745.8417318727001500270
782746.0992696922001500270
7627.146.356807511700150027.10
7627.146.614345331200150027.10
7827.146.871883150800150027.10
7727.147.129420970300150027.10
8227.147.386958789800150027.10
7627.147.644496609300150027.10
5827.147.902034428800150027.10
5027.148.159572248301150027.11
4727.148.41711006781115027.101
4627.148.67464788731115027.101
4327.148.93218570681115027.101
422749.1897235263111502701
372749.4472613459111502701
352749.7047991654111502701
372749.9623369849111502701
262750.2198748044111502701
342750.4774126239111502701
412750.7349504434111502701
422750.992488262910.72727272731502700.7272727273
532751.250026082400.6251500270.625
452751.507563901910.33333333331502700.3333333333
6027.151.765101721400150027.10
7027.152.022639540900150027.10
7627.152.280177360500150027.10
8227.152.5377151800150027.10
8127.152.795252999500150027.10
8127.153.05279081900150027.10
8227.153.310328638500150027.10
8327.153.56786645800150027.10
8327.153.825404277500150027.10
8327.154.08294209700150027.10
8627.154.340479916500150027.10
8427.154.59801773600150027.10
8627.254.855555555600150027.20
8827.255.113093375100150027.20
8827.155.370631194600150027.10
9027.155.628169014100150027.10
8627.155.885706833600150027.10
8527.156.143244653100150027.10
8627.256.400782472600150027.20
8627.256.658320292100150027.20
8627.256.915858111600150027.20
8727.157.173395931100150027.10
8727.157.430933750700150027.10
8827.157.688471570200150027.10
8827.257.946009389700150027.20
9227.258.203547209200150027.20
9127.258.461085028700150027.20
8627.158.718622848200150027.10
8827.158.976160667700150027.10
8727.159.233698487200150027.10
8827.159.491236306700150027.10
8227.259.748774126200150027.20
8327.160.006311945700150027.10
8527.160.263849765300150027.10
8327.160.521387584800150027.10
8127.160.778925404300150027.10
8427.161.036463223800150027.10
8427.161.294001043300150027.10
8727.161.551538862800150027.10
872761.8090766823001500270
892762.0666145018001500270
892762.3241523213001500270
892762.5816901408001500270
912762.8392279604001500270
942763.0967657799001500270
992763.3543035994001500270
1042763.6118414189001500270
1072763.8693792384001500270
962764.1269170579001500270
832764.3844548774001500270
8627.164.641992696900150027.10
9127.164.899530516400150027.10
912765.1570683359001500270
942765.4146061555001500270
942765.672143975001500270
942765.9296817945001500270
9527.166.18721961400150027.10
9527.166.444757433500150027.10
862766.702295253001500270
832766.9598330725001500270
872767.217370892001500270
892767.4749087115001500270
892767.732446531001500270
922767.9899843505001500270
9827.168.247522170100150027.10
9627.168.505059989600150027.10
9127.168.762597809100150027.10
9327.169.020135628600150027.10
9527.169.277673448100150027.10
8927.169.535211267600150027.10
8527.169.792749087100150027.10
962770.0502869066001500270
872770.3078247261001500270
882770.5653625456001500270
862770.8229003652001500270
9227.171.080438184700150027.10
9827.171.337976004200150027.10
952771.5955138237001500270
862771.8530516432001500270
832772.1105894627001500270
872772.3681272822001500270
912772.6256651017001500270
9227.172.883202921200150027.10
8727.173.140740740700150027.10
832773.3982785603001500270
842773.6558163798001500270
872773.9133541993001500270
892774.1708920188001500270
942774.4284298383001500270
9927.174.685967657800150027.10
7727.174.943505477300150027.10
622775.2010432968001500270
732775.4585811163001500270
722775.7161189358001500270
712775.9736567553001500270
812776.2311945749001500270
892776.4887323944001500270
912776.7462702139001500270
942777.0038080334001500270
932777.2613458529001500270
872777.5188836724001500270
882777.7764214919001500270
972778.0339593114001500270
952778.2914971309001500270
952778.5490349504001500270
932778.80657277001500270
912779.0641105895001500270
952779.321648409001500270
972779.5791862285001500270
952779.836724048001500270
952780.0942618675001500270
962780.351799687001500270
972780.6093375065001500270
842780.866875326001500270
842781.1244131455001500270
882781.381950965001500270
922781.6394887846001500270
962781.8970266041001500270
962782.1545644236001500270
882782.4121022431001500270
952782.6696400626001500270
962782.9271778821001500270
962783.1847157016001500270
852783.4422535211001500270
1062783.6997913406001500270
10426.983.957329160100150026.90
902784.2148669797001500270
992784.4724047992001500270
952784.7299426187001500270
892784.9874804382001500270
862785.2450182577001500270
8426.985.502556077200150026.90
8226.985.760093896700150026.90
8226.986.017631716200150026.90
7826.986.275169535700150026.90
802786.5327073552001500270
842786.7902451748001500270
842787.0477829943001500270
8326.987.305320813800150026.90
8626.987.562858633300150026.90
8826.987.820396452800150026.90
7326.988.077934272300150026.90
752788.3354720918001500270
7926.988.593009911300150026.90
802788.8505477308001500270
7926.989.108085550300150026.90
8026.989.365623369800150026.90
7726.989.623161189400150026.90
822789.8806990089001500270
802790.1382368284001500270
7926.990.395774647900150026.90
8226.990.653312467400150026.90
8226.990.910850286900150026.90
8826.991.168388106400150026.90
8726.991.425925925900150026.90
9326.991.683463745400150026.90
9226.991.941001564900150026.90
8826.992.198539384500150026.90
8526.992.45607720400150026.90
7826.992.713615023500150026.90
7626.992.97115284300150026.90
6826.993.228690662500150026.90
6526.993.48622848200150026.90
6826.993.743766301500150026.90
7026.994.00130412100150026.90
7326.994.258841940500150026.90
7226.994.5163797600150026.90
7426.994.773917579600150026.90
7526.995.031455399100150026.90
8026.995.288993218600150026.90
8226.995.546531038100150026.90
8326.995.804068857600150026.90
8326.996.061606677100150026.90
8326.996.319144496600150026.90
8226.996.576682316100150026.90
8726.996.834220135600150026.90
8826.997.091757955100150026.90
8926.997.349295774600150026.90
8826.997.606833594200150026.90
8926.997.864371413700150026.90
9226.998.121909233200150026.90
10226.998.379447052700150026.90
7626.998.636984872200150026.90
7826.998.894522691700150026.90
8426.999.152060511200150026.90
9026.999.409598330700150026.90
8926.999.667136150200150026.90
9026.999.924673969700150026.90
8726.9100.182211789300150026.90
7826.9100.439749608800150026.90
7926.9100.697287428300150026.90
8326.9100.954825247800150026.90
8226.9101.212363067300150026.90
8526.9101.469900886800150026.90
8726.9101.727438706300150026.90
8626.9101.984976525800150026.90
8726.9102.242514345300150026.90
8826.9102.500052164800150026.90
9026.9102.757589984400150026.90
9326.9103.015127803900150026.90
9626.9103.272665623400150026.90
9426.9103.530203442900150026.90
9426.9103.787741262400150026.90
9326.9104.045279081900150026.90
9526.9104.302816901400150026.90
9526.9104.560354720900.1964285714150026.90.1964285714
3926.9104.81789254041115026.901
2726.9105.07543035991115026.901
2126.9105.33296817941115026.901
1926.9105.5905059991115026.901
1726.9105.84804381851115026.901
1726.9106.1055816381115026.901
1626.9106.36311945751115026.901
1526.9106.6206572771115026.901
1426.9106.87819509651115026.901
1326.9107.1357329161115026.901
1326.9107.39327073551115026.901
1226.9107.6508085551115026.901
1226.9107.90834637451115026.901
3926.9108.165884194110.229166666715026.900.2291666667
8726.9108.423422013600150026.90
8526.9108.680959833100150026.90
8526.9108.938497652600150026.90
8526.9109.196035472100150026.90
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78.0015649452416.1123400777108.165884194129.563414634131.12107023417.3947474244
8259810.043132733856.4007824726157.1719192423
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Men fyziologickch veliin
teplota krve a pacienta
tlak krve
saturace krve kyslkem
prtok krve
koncentrace jednotlivch ltek v krvi
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Men teplotyDotykovTermistoryPozistorynegastoryTermoelektrick senzory (Seebeck)Polovodiov senzory s PN pechodem (Schockley)
BezdotykovIR (Planck)
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Invazivn metody men TKkatetr (teflon) vyplnn kapalinou penos tlaku hydrodynamickm vedenm (fyziologick roztok)katetr se snmaem pmo na hrotu nejpesnj men tenzometrick senzor TIP s rznmi snmai (piezoelektrick, kapacitn, optick)
-
Invazivn metody men TKVhodou pmch metod je monost bezproblmovho zskn spojitho prbhu krevnho tlaku.
-
Men prtokuElektromagnetick indukn prtokomr
Bje vektor magnetick indukce[Wb/m2]lje vzdlenost mezi elektrodam[m]vje rychlost proudc krve[m/s]
-
Men SpO2Men oxymetrem2 LED (IR a erven)
Rzn propustnost zen prookyslienou a neokyslienoukrev
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Reference[1] www.jostra.de
[2] David ehk: Teorie mimotlnho obhu, DP VUT 2000
[3] Vratislav Fabin: Teorie mimotlnho obhu (okruhu), FMM, VUT 2003
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Dkuji za pozornost
![[] Teorie C++](https://static.fdocuments.net/doc/165x107/5571f97249795991698f97e5/wwwfisierulmeuro-teorie-c.jpg)
