肺动脉漂浮导管的临床应用课件

《肺动脉漂浮导管的临床应用课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、肺动脉漂浮导管的临床应用Starling定律：心脏的每搏搏出量取决于心脏舒张期的心室内容量（preload）在一定限度内，舒张期心室内容量越大，收缩期每搏量越大最适宜的左心室充盈压为15mmHg(1.99kPa),此时心搏出量最高因此，测定左心的前负荷是理想的指标：左心室舒张未容量（LVEDV）左心室舒张未压力（LVEDP）但临床测定较困难理论基础LVEDP4~12mmHgMean:8mmHgLAP4~12mmHgMean：8mmHgPVPPCWP5~15mmHgMean:10mmHg1970年以前，肺动脉导管是“猪尾巴样”从粗到细很长正常的思维1970年，Ｈ.Ｊ.ＣＳwa

2、n和WilliamGanz发明了带套囊的肺动脉漂浮导管，即Ｓwan-Ganz导管Pressuresintherightsideoftheheartandpulmonarycapillarywedgecanbeobtainedbycardiaccatheterizationwithouttheaidoffluoroscope.ANO.5Frdouble-lumencatheterwithaballoonjustproximaltothetipisinsertedintotherightatriumunderpressuremonitoring.Theballoonisthen

3、inflatedwith0.8mlofair.Theballooniscarriedbybloodflowthroughtherightsideoftheheartintothesmallerradiclesofthepulmonaryartery.Inthispositionwhentheballoonisinflatedwedgepressureisobtained.Theaveragetimeforpassageofthecatheterfromtherightatriumtothepulmonaryarterywas35secondsinthefirst100pat

4、ients.Thefrequencyofprematurebeatswasminimal,andnootherarrhythmiasoccurred.NewEnglandJournalofMedicine(1970)Table6NORMALINTRACARDIACPRESSURES(mmHg)TypeMeanRangeRightatrialpressure51-10Rightventricularend-systolic/end-25/515-30/0-8diastolicpressurePulmonaryarterialsystolic/diastolic23/915-3

5、0/5-15pressureMeanpulmonaryarterialpressure1510-20Pulmonarycapillarywedgepressure105-15Leftatrialpressure84-12Leftventricularend-diastolicpressure84-12Leftventricularsystolicpressure13090-140Table7DERIVEDHEMODYNAMICPARAMETERSFormulaNormalValuesCI=CO/BSA2.8~4.2L/min/m2SV=CO·1000/HR50~110ml/

6、beatSI=SV/BSA30~65ml/beat/m2LVSWI=1.36·(MAP-PCWP)·SI/10045~60g·m/m2RVSWI=1.36·(PAP-CVP)·SI/1005~10g·m/m2SVR=(MAP-CVP)·80/CO900~1400dyne·sec·cm-5SVRI=(MAP-CVP)·80/CI1500~2400dyne.sec.cm-5.m2PVR=(PAP-PCWP).80/CO150~250dyne.sec.cm-5PVRI=(PAP-PCWP).80/CI250~400dyne.sec.cm-5.m2Table8OXYGENDELIV

7、ERYPARAMETERSFormulaNormalValuesArterialO2contentCaO2=(1.39.Hb.SaO2)+(0.0031.PaO2)18~20ml/dLMixedvenousO2contentCvO2=1.39.Hb.SvO2+0.0031.PvO213~16mL/dlArteriovenousO2contentdifferenceavDO2=CaO2-CvO24~5.5mL/dLPulmonarycapillaryO2contentCcO2=1.39.Hb.ScO2+0.0031.