血流动力学监测技术原理及临床应用.ppt

缺点： 微创检查，有一定痛苦、风险 有禁忌症，不适用于所有病人 检查盲区，升主动脉上段、主动脉弓近段 阅读病史，注意检查适应症、禁忌症,与患者及家属说明检查目的和风险,取得TEE检查书面同意书（患者本人及家属） ，胃镜麻醉糖浆10ml含服或2%利多卡因溶液咽部喷雾  TEE检查与操作 ：常规经胸超声心动图，了解心脏情况，确定TEE检查重点 。 接心电监护，取左侧卧位 。 置入牙垫 。探头头端及前段涂布耦合剂 。置入探头进行检查 ，如有活动义 齿要取出，患者口角放置弯盘 * 经食管超声心动图（transesophageal echocardiography, TEE）是将超声探头置入食管内，从心脏的后方向前近距离探查其深部结构，避免了胸壁、肺气等因素的干扰，故可显示出清晰的图像，提高对心血管疾病诊断的敏感性和可靠性，也便于进行心脏手术中的超声监测与评价。 * Derangement in cardiac output may be due to any of these variables, either alone or in combination.  * preload is the pressure stretching the left ventricle of the heart, after passive filling of the ventricle and subsequent atrial contraction. The term end-diastolic volume is better suited to the clinic. Preload is affected by venous blood pressure and the rate of venous return. These are affected by venous tone and volume of circulating blood. Preload increases with exercise (slightly), increasing blood volume (overtransfusion, polycythemia) and neuroendocrine excitement (sympathetic tone). The Frank-Starling law of the heart (also known as Starlings law or the Frank-Starling mechanism) states that the greater the volume of blood entering the heart during diastole (end-diastolic volume), the greater the volume of blood ejected during systolic contraction (stroke volume) and vice-versa. afterload is used to measure the tension produced by a chamber of the heart in order to contract. In the clinic, the term end-systolic pressure is usually more appropriate, although not equivalent. Afterload can also be described as the pressure that the chamber of the heart has to generate in order to eject blood out of the chamber, and thus is a consequence of the aortic pressure, since the pressure in the ventricle must be greater than the systemic pressure in order to open the aortic valve. Everything else held equal, as afterload increases, cardiac output decreases. Derangement in cardiac output may be due to any of these variables, either alone or in combination.  The use of trans-oeso