Hemodynamic monitoring (血流動力監測) of neurocritically ill patientsPPT.pptVIP

Hemodynamic monitoring (血流動力監測) of neurocritically ill patients 雙和醫院 神經內科 紀乃方醫師 Outline Hemodynamics的簡介 監測hemodynamics的目的 監測hemodynamics的方法 腦的代謝 大腦: 2-3% 體重，佔用20%心輸出量 高代謝率 50% 能量維持神經細胞電性活動 25%能量維持離子通道功能 25%能量進行生化合成作用 /departments_and_services/radiology/services/nuclearmedicine/patient/petscan.aspx Hemodynamic monitoring Cardiac monitoring Cardiac rhythm Cardiac output Cerebral monitoring Cerebral blood flow (CBF) Hemodynamic disturbance 腦中風 Ischemic stroke Penumbra Subarachnoid hemorrhage (SAH) Cerebral vasospasm Traumatic brain injury (TBI) Status epilepticus Delayed ischemia Neurogenic stress cardiomyopathy Neurogenic pulmonary edema Cardiac monitoring Cardiac rhythm: EKG monitor Circulation function assessment: Input/ output record Body weight Instrumental assessment Echo Pulmonary artery catheter Cardiac echo 非侵犯性 可順便得到心臟結構影像 便宜，可在bedside做 操作技術會影響結果 Cardiac echo Cardiac Output = Stroke volume(SV) × Heart Rate SV = VTI × CSA CSA = valve orifice cross sectional area VTI = the velocity time integral of the trace of the Doppler flow profile Measuring Cardiac output (by thermal -dilution method) Heart preload (fluid status) Controvesies of its benefit Pulmonary artery catheter /wiki/File:Pulmonary_artery_catheter_english.JPG Table 30-1 in: The Washington manual of surgery. Crit Care Nurse October 2004 vol. 24 no. 5 74-78 Cardiac Index (CI) Cardiac output/ Body surface area Normal =3-5 L/ min/ m2 If 1.8 L/ min/ m2 ? cardiogenic shock Brain hemodynamic monitoring Cerebral blood perfusion (CBF) CT perfusion MR perfusion Cerebral blood flow velocity Transcranial Doppler (TCD) CT/ MR perfusion CBV CBF MTT DWI ADC TMax CT/ MR perfusion Infarction core size evaluation 代表不可逆腦組織損傷的大小 Penumbra (缺血半影區) (PWI/ DWI mismatch area) 大的penumbra代表如果不積極治療，症狀可能惡化 Images from RAPID system