(精选)【重症医学资质培训课件】血流动力学监测和应用教学课件.pptVIP

* * * * * 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. 格拉斯哥昏迷评分(GCS): ［运动：6 - 按吩咐动作 5 - 对疼痛刺激定位反应 4 - 对疼痛刺激屈曲反应 3 - 异常屈曲(去皮层状态) 2 - 异常伸展(去脑状态) 1 - 无反应］ ［语言：5 - 正常交谈 4 - 言语错乱 3 - 只能说出(不适当)单词 2 - 只能发音 1 - 无发音］ ［睁眼 4 - 自发睁眼 3 - 语言吩咐睁眼 2 - 疼痛刺激睁眼 1 - 无睁眼］ 格拉斯哥昏迷评分(GCS): ［运动：6 - 按吩咐动作 5 - 对疼痛刺激定位反应 4 - 对疼痛刺激屈曲反应 3 - 异常屈曲(去皮层状态) 2 - 异常伸展(去脑状态) 1 - 无反应］ ［语言：5 - 正常交谈 4 - 言语错乱 3 - 只能说出(不适当)单词 2 - 只能发音 1 - 无发音］ ［睁眼 4 - 自发睁眼 3 - 语言吩咐睁眼 2 - 疼痛刺激睁眼 1 - 无睁眼］ All fluid-filled systems are under damped, meaning they don’t quickly stop the system from oscillating. Some damping of fluid-filled systems is required, but the greater the damping, the less accurate the waveform. Damping becomes an important factor in hemodynamic measurements only when the natural frequency of the system is not adequate or optimal. The PAC measures pressures in a heart chamber or vessel within the thorax. Therefore, in addition to the intrinsic pressure changes that occur within the chamber or vessel, the heart and great vessels are subject to changes in the surrounding pleural (extrinsic) pressure caused by breathing. Correct measurement of hemodynamic pressure waveforms requires the use of a graphic recording that allows correct identification of end-expiration. To locate end-expiration during spontaneous breathing, locate the waveform just prior to the decline in pressure that occurs with spontaneous inhalation. With mechanical breathing, locate the waveform just prior to the rise in pressure that occurs with mechanical inhalation. 调零/水平面调整 静脉静力点 测量胸廓中部水平 确定第4肋间隙 定标该位置 患者仰卧至45°测量压力 影响右房压和肺动脉楔压测量准度及精度的技术纰漏 平衡及校正 评估动态反应 调零和