漂浮导管应用及解读课件.ppt

精选 1、漂浮导管根本原理，心动周期概念，DPA≈PAWP+1～3 2、肺动脉III区在哪里？如何判断（胸片，压力）？ 由于肺血管内压力和肺泡压（PA）存在着差别，使肺各部血流分布不一。West认为站立对全肺可分为：肺上部（Ⅰ区）通气多而血流少，则PA肺动脉压（Pa）肺静脉压（Pv）；肺中部（Ⅱ区）通气和血流相似。PaPAPv；肺下部（Ⅲ区）血流多，而通气少，PaPvPA。因Ⅰ、Ⅱ区在PAC气囊充气后，肺小动脉分支血流充盈不佳，肺血管和左心房之间未形成充满的静态血栓，因此，测PAWP不能准确反映左房压（LAP）。Ⅲ区的肺小动脉分支内PaPvPA血管床与左心房之间，犹如一根管道，测PAWP能准确反映LAP。因此，PAC的正确位置应在相当于左心房水平的肺小动脉分支内。仰卧时，肺大部分的血管压力和肺泡压力于Ⅲ区。机械通气采用PEEP时，由于PA升高，致使Ⅲ区转为Ⅱ、Ⅰ区，此时测PCWP就不能准确反映LAP变化。 Changes in intrathoracic (pleural) pressure as a result of inhalation and exhalation during breathing cause pressures in the heart to vary accordingly. During spontaneous inspiration the associated decline in pleural pressure causes the hemodynamic pressures measured by the PAC to fall. This is a normal phenomenon. The reverse occurs during mechanical inhalation, which causes the hemodynamic pressures measured by the PAC to rise. To minimize the respiratory effects on the measured hemodynamic pressures, it is essential to always measure all hemodynamic waveform pressures at end-expiration, when pleural pressure is closest to zero. This is true if the patient is breathing spontaneously, or if breathing mechanically. 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. 根据混合静脉血氧饱和度(SvO2)测量结果，其诊断和治疗原则（如图所示）矩形文框所示处理方案。 漂浮导管应用及解读 中山市中医院 精选 * ICU医生缺乏PAC的相关知识 目的: 评价欧洲国家ICU医生对PAC相关知识的了解程度 设计: 调查问卷 背景: 86个欧洲大学及非大学医院ICU 对象: 从两个欧洲危重病医学会目录中选取134个ICU. 其中86个ICU的535名医生参加问卷调查 干预: 在每个ICU中, 所有医生均被要求同时完成一项调查问卷, 包括31个多选题, 涉及床旁留置PAC的所有方面 Gnaegi A, Feihl F, Perret C. Intensive care physician’s insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220 精选 * ICU医生缺乏PAC