课件：血流动力学监测波形分析.ppt

* * * * 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. * 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 c