导管应用技巧与临床解读课件幻灯

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1、Swan-GanzCatheterizationTechniques北京协和医院加强医疗科崔娜1967年加州大学洛杉矶分院Dr.Swan由顺着洋流飘回港湾的帆船，联想到带气囊的心脏导管可以随血流在心脏内向前漂移。1970年Swan与Ganz合作研制了顶端带气囊的血流导向肺动脉漂浮导管(Balloon-tipflow-directedCatheter),并应用于临床。SwanHJCandGanzW.Catheterizationoftheheartinmanwithuseofaflow-directedba

2、lloon-tippedcatheter.NEngJMed1970;283:447Swan-Ganz导管Swan-GanzSwan-GanzCatheter_CuiNa2010-3-28ThermistorConnectorBalloonThermocouplewireConnectorBalloonInflationvalveRA/ProximalInjectionLumenHubPA/DistalLumenHubBalloonBandsBalloonInflationvalveThermistorBack

3、formBandsThermocouplewireConnectorRA/ProximalInjectionLumenHubSVO2OpticalConnectorPA/DistalLumenHubBalloonInflationvalveBalloonSwan-GanzCVP/ProximalInfusionLumenHubPA/DistalLumenHubBalloonInflationvalveThermistorConnectorBalloonThermistorBackformSVO2Optical

4、ConnectorThermocouplewireConnectorRA/ProximalInjectionLumenHubThermocouplewireonthesurfaceofthecatheterBandsSwan-GanzPVC聚氯乙烯材料导管直径“French”,以不同颜色标示：硬度“shore”,临床“触觉”及“扭结”辐射透不过染料,X光下可见4F-红色/粉红；5F-白色；6F-蓝色；7&8F-黄色导管长度:成人一般为110cm,儿科为60-75cmSwan-Ganz临床应用技巧Swan-Ga

5、nz置管监测数据解读2010-3-28Swan-GanzCatheterCuiNa测量左心与右心氧供与氧耗穿刺路径:右颈内静脉最为常用注意事项：床旁备有除颤器和利多卡因、肾上腺素等急救药品可靠静脉通路；Sedinger穿刺法将导管鞘套在静脉扩张器外，通过导丝送入，退出导丝及静脉扩张器后即可通过导管鞘插入Swan-Ganz导管。(成人7号，小儿5号）无菌操作Swan-Ganz置管准备好穿刺针、导丝、扩张器、外套管、Swan-Ganz导管、压力传感器及冲洗装置等PAC外套上保护鞘，将肺动脉腔及CVP腔用盐水冲注，

6、与标定好的换能器相连，注1.5ml气体检查气囊是否匀称Swan-Ganz置管Swan-Ganz置管Swan-Ganz置管Swan-Ganz置管Swan-Ganz置管Swan-GanzInsertionSwan-Ganz置管Swan-Ganz置管—肺区的概念3区2区1区1区2区3区Swan-Ganz置管临床应用技巧Swan-Ganz置管监测数据解读2010-3-28Swan-GanzCatheterCuiNa测量左心与右心氧供与氧耗实际测量的关键环节“通畅”FastFlushTest(SquarewaveTes

7、t)Swan-Ganz测量“调零”“衰减”压力传感器隔膜前端液体平面右心房水平,腋中线第四肋间隙收缩压变低舒张压增高AssumptionsofTDCODeterminationsForwardBloodFlowAdequateMixingofBloodandInjectateSteadypulmonaryarterybaselinetemperatureSwan-Ganz测量IntermittentBolusThermodilutionSwan-Ganz测量IntermittentCOMeasurements

8、TechnicalIssuesSmoothsteadyinjectionAppropriatevolumeofinjectateTimingofinjectateAveragingstrategyAppropriatecomputationconstantSwan-Ganz测量8amCO/CI6.0/3.04pmCO/CI3.6/1.8Roominjectate…..bagonmonitorandw