血流动力学监测波形中心静脉压协和杜斌素材.ppt

* In these waveforms, note the waveforms circled at end-expiration. During spontaneous breathing (top waveform), end-expiration is the waveform just before the pressure declines. During mechanical ventilation (lower waveform), end-expiration is the waveform just before the pressure rises. * As illustrated in this pressure tracing, measurement of a pressure waveform at end-expiration during spontaneous breathing is done by locating and measuring the waveform just prior to the decline in pressure that marks the beginning of inhalation. * Correct measurement of this CVP/RA waveform during spontaneous breathing is done by locating the start of the pressure decline (signaling the beginning of inhalation) and finding the a wave just prior to this decline. This a wave is averaged to obtain the mean CVP/RA value of 12 mm Hg. * 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 o