血流动力学监测精品.pptVIP

* USOM Practical Training Program January 2006 * The Doppler effect can be defined as “the change in frequency or wavelength due to motion of the wave source, receiver, or reflector of a wave source” The Doppler principle is simply that sound pitch increases as the source moves toward the listener and decreases as it moves away. this can be explained quite simply by referring to common sounds in the every day world such as race cars or sirens moving towards or away from a stationary listener – the pitch increases as the sound is moving towards you and decreases as it moves away. * USOM Practical Training Program January 2006 * This is also true for blood flow and is used to assess direction of flow and velocity of flow. * * * Cedar’s Sinai 医院是PAC（肺动脉导管）的起源地。在那里，医师Swan 和Ganz 于1970年发明了Swan-Ganz（PAC）导管。 * 血液的密度一般约在1.050～1.060之间。血液的密度与所含血细胞的数量和血浆的成分有关，通常随着血细胞数量的变化而变化。红细胞的血液密度约1.115，白细胞的血液密度约为1.070。 粘滞性是指液体流动阻力的大小。血液的粘滞性（blood viscosity）的高低主要取决于血液中血细胞的数量和血浆的成分。通常情况下，血液的粘滞性是水的3.5～5.5倍。 * * * * * * * * * 主要参数及其意义 * Vpk = Peak Ejection Velocity（峰值速度） 正常值（m/s)：AV：1.1-1.5 PV 0.8-1.2 Vpk影响因素 *心肌收缩力 *血管阻力 *血液粘稠度 * SV = Stroke volume（每搏输出量） vti = ∫速度·时间 (每搏距离) SV =vti X CSA * * SV正常值： 1.1-1.75ml/kg 影响因素 *心肌收缩力 *前负荷：容量 *血管阻力 *血液粘稠度 * ET%=Ejection Time%射血时间比 正常值(%)： 30-45 影响因素 *心肌收缩力 *前负荷：容量 *血管阻力 *血液粘稠度 * CO / CI = Cardiac Output / Index 正常值： CO 3.5-8 CI 2.8-4.2 * MD = Minute Distance分钟距离 正常值 ： AV:14 – 22 m/min PV:10 – 16 m/min * MD AV PV 高动能 (22 m/min) (16 m/min) 正常动能 (14 – 22 m/min) (10 – 16 m/min) 低动能 (14 m/min) (10 m/min) 显示循环动能状态 * SVR = Systemic Vascular Resistance 正常值：800-1600 影响因素 *血液粘滞度 *血管半径 *血流速度 SVR= (MAP – CVP) x 80 CO * * * * * * * * * Inotropy = BPm x SV x 10-3 + 1x SV x 10-6 x ρ x Vm2 7.5 x FT 2 x FT 史密斯-麦迪根公式 (Annals of Emergency Medicine 2008; 51, No 4: 480.) The Smith-Madigan Formula 心脏收缩力 BPm = (mean arterial pressure – central venous pressure)