Theoretical Establishment of a New Algorithm for Intra-Aortic Balloon Pumping for the Patients with Atrial Fibrillation, and Its Clinical Application.

在房颤的病例中，左心室(LV)的舒张末容量受LV充盈时间(即心电图上R-R间期之前)的调节。从这个角度出发，我们设计了一种新的算法，即IABP球囊扩张的时机由前一次R-R间期与中心动脉R-R间期和R-二向心切迹间期之间的回归方程决定，并与商用驱动器中使用的其他五种算法进行了比较。[方法]在本研究项目第一年分析并建立统计拟合优度的二次回归方程的基础上，我们利用心脏手术后即刻应用主动脉内球囊反搏的心房颤动患者的心电图和中心动脉压波形对新算法进行了测试。最后，我们发明了一种新的主动脉内球囊反搏驱动器，在该驱动器中，…之间的二次回归方程在主动脉内球囊反搏的周期性短暂停止时，自动计算更早的R-R间期和R-二向切迹间期，并用新计算的方程重新调整球囊充气的最佳时机。[结果]二级方程具有统计学意义，拟合度较好，但在R-R间期大于900 mec时这些参数之间呈线性关系。决定系数分布在0.6~0.75之间。在与商用驱动程序中使用的算法的比较研究中，新算法显示出最优的定时和标准差(S.D.)与其他五种驱动程序相比，新算法的最佳充气时机(主动脉二叉切迹)与真实时机之间的时间差最小，具有统计学意义。新算法的SD值为8.50毫秒，对房颤反应最好的Kontron K-2000为14.89毫秒。AVCO Model-10型，算法无效，为54.44毫秒。最后，针对房颤患者，设计了一种新的基于该优化算法的驱动器，并将其应用于临床，取得了明显的血流动力学改善。较少

In a case with atrial fibrillation, left ventricular(LV) end-diastolic volume is regulated by LV filling time (namely, preceding R-R interval on ECG). From this view point, we devised a new algorithm that the timing of IABP balloon inflation is decided by a regression equation between preceding R-R interval and interval of R-dicrotic notch in central aortic pressure, and compared the new algorithm with other five algorithms used in commercially available drivers.[Methods] on the basis of secondary regression equations which were analyzed and established statistical goodness of fit in the 1st year of this research project, we tested this new algorithm using the ECG and central aortic pressure waves recorded simultaneously from the patients with atrial fibrillation who had undergone cardiac operation and applied intra-aortic balloon pumping immediately after the surgery. Finally, we invented a new driver for intra-aortic balloon pumping, in which the secondary regression equation between … More preceding R-R interval and R-dicrotic notch interval is calculated automatically during the periodical short stop of the intra-aortic balloon pumping and the optimal timing of balloon inflation is readjust using newly calculated equation.[Results] The secondary equations were revealed statistical significance and good fitness but the relationship between these parameters became liner in the R-R interval longer than 900 mesc. and the decisive coefficient value were distributed from 0.6 to 0.75. In the comparative study of this new algorithm with the algorithms used in commercially available drivers, the new algorithm showed most optimal timing and the standard deviation(S.D.) of timing difference between the best inflation timing (aortic dicrotic notch) and the true timing of this new algorithm showed smallest value with statistical significance compared with other five drivers. The S.D. value in new algorithm was 8.50 msec., Kontron K-2000, which had most excellent response to atrial fibrillation, showed 14.89 msec. and AVCO model-10, which had ineffective algorithm, 54.44 msec. Lastly, we made a new driver regulated by this new optimal algorithm for the patients with atrial fibrillation and applied clinically with marked hemodynamic improvements. Less