氧供需平衡麻醉.ppt

The factors influence transport of oxygen Cardiac output Blood oxygen content (CaO2) The affinity of hemoglobin for oxygen Physiological supply dependency The normal relationship is for a 4:1 ratio between DO2 and VO2. ↑ or ↓ in CO and DO2 do not affect oxygen consumption. Pathological supply dependency Relationship between DO2 and VO2 seen in critically ill patients, when increases in CO or increases in oxygen delivery, result in parallel increases in VO2. 氧需Oxygen demand Oxygen demand is the actual amount of oxygen needed per minute. -is closely related to the oxygen consumption; -Under some conditions, demand may exceed consumption. Monitoring? 测定Hct及Hb的方法 全血细胞分析仪-- Hct、Hb 血气分析仪– Hct、Hb 血红蛋白分光光度仪-- Hb 离心机—Hct 反射式脉搏氧饱和度探头 经气管混合静脉血氧饱和度监测 术中常用的CO监测方法 右心飘浮导管 Picco (外周动脉) FloTrac 传感器 TEE 由动脉压力波形计算CO PiCCO Using PiCCO typically requires insertion of a thermodilution catheter in the femoral or axillary artery instead of a standard arterial line. Any available central venous catheter can be used to inject the solution for the thermodilution analysis. 术中TEE测量CO M型法 短轴缩短率： FAC=(EDA-ESA)/EDA ; 自动边缘识别系统（ABD） 二维Simpson法 SV=LVEDV-LVSDV 多谱勒法 SV=时间速度积分X横截面积 三维法 Calculation of the shunt fraction Qt = total cardiac output Qs = shunted portion of cardiac output Qns = normal pulmonary end-capillary blood flow that is not shunted past abnormal alveoli Qt = Qs + Qns or Qns = Qt - Qs Calculation of the shunt fraction Qt (CaO2) = total oxygen delivered to the body (DO2) Qs (CvO2) = oxygen content of shunted blood Qns (CcO2) = oxygen content of end-capillary blood Total oxygen delivered equals the sum of oxygen in both shunted and non-shunted blood Qt (CaO2) = Qs (CvO2) + Qns (CcO2) Calculation of the shunt fraction Substituting (Qt - Qs) for Qns Qt (CaO2) = Qs (CvO2) + (Qt - Qs)(CcO2) Qt (CaO2) = Qs (CvO2) + Qt (CcO2) - Qs (CcO2) Qs (CcO2 - CvO2) = Qt (CcO2 - CaO2) The intrapulmonary shunt equation Qs/Qt = CcO2 - CaO2 /CcO2 - CvO2 Gastri