血流动力学监测波形分析—培训课件.pptVIP

* In this practice example, what is the value of this CVP during spontaneous breathing? * Measurement of the mean of the a wave prior to the decline in pressure is 13 mm Hg. (Note that spontaneous end-expiration occurs immediately before the pressure starts to decline.) * In this practice example, what is the CVP value in this patient on unassisted mechanical ventilation? * Measurement of the mean of the a wave prior to the rise in pressure is 5 mm Hg. * SLIDE 6 Waveforms may exhibit abnormalities in their numerical values or in their wave pattern characteristics, or both. * SLIDE 7 Abnormalities in the value of the CVP/RA pressures may be abnormally high or abnormally low. Elevations in the mean CVP/RA pressures can occur in conditions of volume overload, right ventricular failure, tricuspid stenosis or regurgitation, cardiac tamponade, constrictive pericarditis, pulmonary hypertension or chronic left ventricular failure. Low mean CVP/RA pressure values can occur in the condition of hypovolemia. * SLIDE 9 Abnormalities may also occur in the characteristic waves of the CVP/RA or PAOP waveforms. An abnormal appearance may occur in either the a waves or the v waves of the CVP/RA or PAOP waveforms. * SLIDE 10 The a waves of CVP/RA or PAOP waveforms may be exaggerated (large) or may be absent. Large a waves may occur with tricuspid or mitral stenosis or with non-compliant, hypertrophied ventricles. Large a waves also may occur as a result of atrial systole against a closed atrio-ventricular valve due to atrial-ventricular asynchrony. These large waves are termed cannon waves and may occur intermittently in the presence of complete heart block or ventricular tachycardia, or regularly in the presence of junctional rhythms or any other A-V dissociation rhythm. A waves are absent in both the CVP/RA and PAOP waveforms in any rhythm in which electrical P waves are absent. This includes atrial fibrillation, junctional rhythms, paced rhythms and ventricular rhythms. * S