课件：cv.ppt

表6 PAWP与LVEDP差异的各种情况 PAWP＞LVEDP PAWP＜LVEDP 1.正压通气 1.主动脉瓣返流 2.PEEP 2.左心室顺应性降低 3.胸内压↑ 3.肺动脉分支减少 4.PAC不在肺III区 （全肺切除术、肺栓塞 ） 5.慢性阻塞性肺疾患 6.心动过速 7.肺血管阻力↑ 8.二尖瓣阻塞（狭窄） 9.肺静脉受压（肿瘤） 10.二尖瓣返流 11.心内左向右分流 PCWPLVEDP Positive-pressure ventilation PEEP Increased intrathoracic pressure Non-West Lung Zone III PAC placement Chronic obstructive pulmonary disease Increased pulmonary vascular resistance Left atrial myxoma Mitral valve disease(stenosis,regurgitation) PCWPLVEDP Noncompliant LV(ischemia,hypertrophied LV) Aortic regurgitation(premature closure of the mitral valve) LVEDP25mmHg 并发症（1） 中心静脉穿刺引起的并发症 误入动脉 血肿 神经损害 气胸 气栓 并发症（2） 插管过程中引起的并发症 一般心律失常 严重心律失常（室速、室颤） 右束支传导阻滞 完全性传导阻滞（主要指原有RBBB） 并发症（3） 导管留置过程中 肺动脉破裂、肺出血 气囊破裂 感染 血栓形成和栓塞：血栓性静脉炎，静脉 栓塞，心内膜血栓形成，瓣膜赘生物等 肺梗死 并发症（4） 导管扭曲、打结、折断 心脏机械性损伤 Table 7 PRACTICE GUIDELINES FOR PULMONARY CATHETER USE ( ASA TASK FORCE ON PULMONARY ARTERY CATHETERIZATION ) Opinions PA catheter monitoring can reduce the incidence of perioperative complications,primarily by providing immediate access to critical hemodynamic data Having immediate access to PA catheter data allows important preemptive measures for that subset of patients who encounter hemodynamic disturbances that require immediate and precise decisions about fluid management and drug treatment. Experience and understanding are the major determinants of PA catheter effectiveness PA catheterization is inappropriate as a routine practice in surgical patients and should be limited to cases in which the anticipated benefits of catheterization outweight the potential risks. Table 8 PRACTICE GUIDELINES