肺动脉漂浮导管_PAC.ppt

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1、肺动脉漂浮导管的应用ContentsIntroductionPACPlacementHemodynamicMonitoringControversyonPACParameterintegrationCasesDiscussionWhatisPulmonaryArteryCatheter?Fullname:Swan-GanzCatheterUsedittomonitorapatient’shemodynamicswhenwecantanswerthequestionusingnoninvasive/clinicalmeasures

2、ClinicaluseofthePAC（Diagnosis）DifferentiationamongcausesofshockCardiogenicHypovolemicDistributive(sepsis)Obstructive(massivepulmonaryembolism)DifferentiationofpulmonaryedemaCardiogenicNoncardiogenicEvaluationofpulmonaryhypertensionDiagnosisofleft-to-rightintracardiac

3、shuntDiagnosisofpericardialtamponadeClinicaluseofthePAC（Therapy）ManagementofperioperativepatientwithunstablecardiacstatusManagementofcomplicatedmyocardialinfarctionManagementofseverepreeclampsiaGuidetopharmacologictherapyVasopressors；Inotropes；VasodilatorsGuidetononp

4、harmacologictherapyFluidmanagement；Burns；Renalfailure；Sepsis；Heartfailure；DecompensatedcirrhosisVentilatormanagementAssessmentofbestPEEPforDO2ContentsIntroductionPACPlacementHemodynamicMonitoringControversyonPACParameterintegrationCasesDiscussionStructureofPACPAC首选：右

5、颈内静脉ComparisonamongPAcatheterinsertionsitesPACinsertionRightinternaljugularveinShortestandstraightestpathtotheheartLeftsubclavianDoesnotrequirethePACtopassandcourseatanacuteangletoentertheSVCFemoralveinsDistantsitesPassingaPACintotheheartcanbedifficultFluoroscopicass

6、istancemaybenecessaryCompressibleandpreferableiftheriskofhemorrhageishighPACinsertionAfterinsertingthePACasfarasthe20cmmark，theballoonisinflatedwithair.Inflationshouldbeslowandcontrolled(1mL/s)andshouldnotsurpasstherecommendedvolume(1.5mL).Alwaysinflatetheballoonbefo

7、readvancingthePACandalwaysdeflatetheballoonbeforewithdrawingthePAC.CRX：checkthepositionofthePACPAdiastolicpressure~PAWPPAConCRX（PA）PlacementofthecatheterRightAtrium>>20cmNormalrightatrialpresssureis0-6cmHg.Normaloxygencontent15%（ml/dL)NormalO2saturation75%Waveformsof

8、CVPEKG-RAPEKGMechanicaleventRAP80–100millisecondsafterPwaveRAsystoleawaveRAdiastolexdescentAfterQRSTricuspidvalveclosurecwaveAfterp