重症监护产品知识概要指南

1、GuidelinesofCriticalCareProductKnowledgeRequirementPart1AnatomyandPhysiology第一部分解剖和生理一VascularAnatomy血管解剖Objectives目标1Describethepurposeofthevascularsystem描述血管系统的用途2Identifythemainstructuresofthethoraciccavity识别胸腔的主要结构3Identifythefollowingarteriesandveinsinthethoraciccavity:识别在胸腔中的以下动脉和静脉ArteryVein动

2、脉静脉- aortic arch 主动脉弓- ascending aorta 升主动脉- descending thoracic aorta- brachiocephalic (innominate)- inferior vena cava- superior vena cava降主动脉头臂动脉(无名动脉)上腔静脉下腔静脉- left main coronary 左主冠脉- left subclavian 左锁骨下动脉- pulmonary 肺动脉- right coronary 右冠脉- right subclavian 右锁骨下动脉4 Identify the following arte

3、ries and veins in the vascular system: 识别以下的血管系统的动脉和静脉Artery动脉- brachial 臂动脉- femoral 股动脉- iliac 髂动脉- popliteal 腘动脉- renal arteries 肾动脉- abdominal aorta 腹主动脉- descending thoracic aortaVein静脉- brachial 臂静脉- femoral股静脉- iliac髂静脉- popliteal腘静脉- renal veins 肾静脉- axillary腋静脉降主动脉 - cephalic 头静脉- external

4、carotid 颈外动脉- internal carotid 颈内动脉- left common carotid 左颈总动脉- radial 桡动脉- posterior tibial 胫后动脉- ulnar artery 尺动脉- vertebral 椎动脉- external jugular颈外静脉- internal jugular颈内静脉- saphenous 大隐静脉- subclavian 锁骨下静脉-dorsalispedis足背动脉CardiacAnatomy心脏解剖Objectives目标1 Describethepurposeoftheheart描述心脏的用途2 Ident

5、ifythefollowingstructuresinthethoraciccavity:识别胸腔内的以下结构：- rightatrium右心房-leftatrium左心房- rightventricle右心室-leftventricle左心室- apexoftheheart心尖-pericardium心包3 Identifythefollowingstructuresonacross-sectionoftheheart:识别以下的心脏横截面结构：- mitral valve 二尖瓣- tricuspid valve 三尖瓣- chordae tendineae 腱索- papillary m

6、uscles 乳突肌- interventricular septum 室间膈- rightatrium右心房- leftatrium左心房- rightventricle右心室- leftventricle左心室- pulmonaryvalve肺动脉瓣- aorticvalve主动脉瓣4 Identifytheanatomicalfunctionsofthefollowingstructures:识别以下结构的解剖功能- right atrium右心房- left atrium左心房- right ventricle右心室- left ventricle左心室- pulmonary valv

7、e 肺动脉瓣三 Cardiac Cycle- aortic valve 主动脉瓣- mitral valve 二尖瓣- tricuspid valve 三尖瓣- chordae tendineae腱索- papillary muscles乳突肌心动周期Objectives目标1 ExplainhowthecardiaccyclerelatestotheECGandhemodynamicwaveform解释心动周期和心电图以及血流动力学波形是如何相关的2 Identifythephasesofthecardiaccycle识别心动周期的各个阶段3 Describewhatishappeningd

8、uringeachphaseofthecardiaccycle描述在每个心动周期阶段中发生什么四DeterminantsofCardiacOutput心排量决定因素Objectives:目标1Define定义- preload前负荷- afterload后负荷- contractility心肌收缩力- cardiacoutput心排量- cardiacindex心排指数- strokevolume每搏量- strokevolumeindex每搏指数- systemicvascularresistance体循环阻力- pulmonaryvascularresistance肺循环阻力- leftv

9、entricularstrokeworkindex左心室每搏功指数- rightventricularstrokeworkindex右心室每搏指数- myocardialoxygensupply心肌氧供应- myocardialoxygendemand心肌氧需求2Identifythefactorsthataffect识别影响以下内容的因素- preload前负荷- afterload后负荷- contractility心肌收缩力- myocardialoxygensupply心肌氧供应- myocardialoxygendemand心肌氧需求Part2PRESSUREMONITORING第二

10、部分压力监测一ClinicalFundamentals临床基本知识1 ComponentsofPressureMonitoringSystems压力监测系统的组成?ElectricalSystem电子系统?Plumbing/FluidSystem冲刷/液体系统?Continuousflushdevice连续冲刷装置?Pressuretransducer压力传感器?Pressurebag压力包?IVsolution(withorwithoutheparin)静脉输注液体(含或不含肝素)2 Equipmentset-up系统设置?Setpressurescaleinmonitoringsystem

11、在监护系统上设置压力刻度?Assemblesystemandflushsystemwithsolution装配系统并用液体冲刷系统?Setpressurebagto300mmHg将压力包加压到300mmHg?Zeroingandreferencingthecatheter-tubing-transducersystem调零并定位导管管路传感器系统3 Interferencewithinthesystem系统内部的干扰?Dynamicresponse动力学反应?Frequencyresponse固有频率?Damping衰减?Squarewaveformresponse方波测试4 Maintena

12、nceofSystem系统维护?Issueswithfrequencyofzeroing调零的频率问题维持压力包内的压力 (300mmHg)Maintainpressure(300mmHg)withinpressurebag?Drawingbloodsamples抽取血液样品5 WheretotakeReadingsofPressureMeasurements在何处读取压力监测的读数?Effectsofrespiration(inhalation/exhalation)呼吸的影响(吸气/呼气)?Readingsbesttakenatend-expiration最好在呼气末期读取读数Sponta

13、neousBreathing自发呼吸MechanicalVentilation机械通气6 .ProblemsthatMayBeEncountered-Troubleshooting可能遇到的问题故障排除?Dampedwaveform衰减波形?Abnormallylowornegativepressures不正常的低压或者负压?Inabilitytowedge无法契入?Falsehighpressurereadings错误的高压力读数?OverwedgingofPAWpressuretracing过度契入的肺动脉契压波形?Catheterwhip导管漂移?Inabilitytoflush/dra

14、wblood无法冲刷/抽血7 ArterialPressureMonitoring动脉压力监测?Purpose目的?Sites位点?Waveform波形?Complications并发症8 Bloodperforms2mainfunctionswhilecirculatingtheBody血液在体内循环时的2个主要功能9 Factorsthatcontrolbloodpressure控制血压的因素?Increased/decreasedheartrate心率增加/降低?Heartpumpingtoomuch/toolittleblood心脏泵血过多/过少?Someorgansarebypass

15、ed,i.eshockoraftermeals某些器官分流，比如，休克或者进餐后?Thickeningofarteries动脉增厚?Constrictionofarteries动脉收缩10 .TypicalPressuresandValues典型的压力和数值右心排空压力左心充盈压肺动脉压肺动脉阻断压/契压右心充盈压左心排空压力中心静脉压动脉压RightHeartEmptyingpressureLeftHeartFillingPressurePulmonaryArteryPressurePAOP/PAWPRightHeartFillingPressureLeftHeartEmptyingPres

16、sureCentralVenousPressureArterialPressure11 .Whymeasurepressures为什么测定压力？12 Whichproductsaretraditionallyusedtoaccessthesepressuremeasurements在测定上述压力时应用的传统产品是什么？Part4HemodynamicMonitoring第四部分血流动力学监测1 Thegoalofthehemodynamicmonitoring血流动力学监测的目标2 Thepurposeofhemodynamicmonitoring血流动力学监测的目的?Prevention预防

17、?Diagnosis诊断?Management管理3 CardiacOutput心排量?Definition定义?Formula公式?NormalCardiacOutput正常心排量4 CardiacIndex心排指数?Definition定义?Normal正常值?Impactofheartrate心率的影响?Bradyarrhythmias?Tachyarrhythmias?StrokeVolume每搏量?Definition定义?Determinants决定因素Preload前负荷Afterload后负荷Contractility收缩力5 Controversiessurroundingt

18、heuseofthePulmonaryArteryCatheter(PAC)围绕肺动脉导管应用的争议?1996-the"Connors"study1996年“Connors”研究?Practitionerknowledgeregardingtheuseofhemodynamicparameters执业医师对于血流动力学参数应用的知识?1996SCCMPACConscensusMeeting1996年重症监护医学会肺动脉导管研讨会?Today:现在：?PACEP肺动脉导管教育项目?Outcomestudies结果研究?Pursuitof“non-invasive"t

19、echnology:追击“碰匚技术Bioimpedencecardiacoutputmeasurements生物阻抗心排量测士7ETransesophagealechocardiograms/probes经食道超声/探头LITCO锂指示剂稀释法心排量测定Pulsion动脉压力波形和脉搏轮廓分析心排量测定6 .ThePulmonaryArteryCatheter肺动脉导管?CatheterPorts导管端口?Proximalport近端端口?VIPportVIP端口?Distalport?Balloonport?Thermistor?SideportonIntroducerSheath7 .In

20、dicationsforPulmonaryArteryPressureMonitoring肺动脉压力监测的适应症8 .Direct&DerivedParametersAssociatedwithHemodynamicMonitoring和血流动力学监测相关的直接和衍生参数?Direct直接?DerivedParameters衍生参数9 .InsertionofPAC肺动脉导管插入?Insertionsites插入位点?Insertionmethods插入方法?Observeforwaveformchangesduringtheinsertion在插入过程中观察波形的变化?RightAt

21、rialPressure右心房压力?PurposeforUse应用的目的?Normals正常值Neonate新生儿Child儿童Adult成人?RAWaveform右心房压力波形RightVentriclePressure右心室压力?PurposeforUse应用的目的?Normals正常值Neonate新生儿Child儿童Adult成人?RVWaveform右心室波形PulmonaryArteryPressure肺动脉压?PurposeforUse应用的目的?PAsystolicpressure肺动脉收缩压?PAdiastolicpressure肺动脉舒张压?PAmeanpressure(P

22、AM)肺动脉平均压PulmonaryArteryWedgePressure(Pawp/Paop)?Assumptions假设?Inflationvolume球囊充盈容量Normals正常值WaveformNeonateChildAdult波形新生儿儿童成人?CatheterMaintenance导管维护?ProblemswithPAcatheters/lines肺动脉导管/线路使用的问题10DERIVEDPARAMETERS衍生参数MeanArterialPressure?Formula公式平均动脉压?Normal正常值Definition定义CausesofincreasedMAP平均动脉压增高的原因CausesofdecreasedMAP平均动脉压降低的原因平均肺动脉压MeanPulmonaryArteryP