重症监护产品知识概要指南.docx

Guidelines of Critical Care Product Knowledge Requirement Part 1 Anatomy and Physiology第一部分 解剖和生理一Vascular Anatomy 血管解剖Objectives目标1 Describe the purpose of the vascular system 描述血管系统的用途2 Identify the main structures of the thoracic cavity 识别胸腔的主要结构3 Identify the following arteries and veins in the thoracic cavity: 识别在胸腔中的以下动脉和静脉 Artery Vein 动脉 静脉- aortic arch 主动脉弓 - inferior vena cava 上腔静脉- ascending aorta 升主动脉 - superior vena cava 下腔静脉- descending thoracic aorta 降主动脉- brachiocephalic (innominate) 头臂动脉（无名动脉）- 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 arteries and veins in the vascular system:识别以下的血管系统的动脉和静脉Artery Vein动脉 静脉- brachial 臂动脉 - brachial 臂静脉 - femoral 股动脉 - femoral 股静脉- iliac 髂动脉 - iliac 髂静脉- popliteal 腘动脉 - popliteal 腘静脉 - renal arteries 肾动脉 - renal veins 肾静脉- abdominal aorta 腹主动脉 - axillary 腋静脉- descending thoracic aorta 降主动脉 - cephalic 头静脉- external carotid 颈外动脉 - external jugular 颈外静脉- internal carotid 颈内动脉 - internal jugular 颈内静脉- left common carotid 左颈总动脉 - saphenous 大隐静脉- radial 桡动脉 - subclavian 锁骨下静脉- posterior tibial 胫后动脉- ulnar artery 尺动脉- vertebral 椎动脉- dorsalis pedis 足背动脉二Cardiac Anatomy 心脏解剖Objectives目标1 Describe the purpose of the heart 描述心脏的用途2 Identify the following structures in the thoracic cavity: 识别胸腔内的以下结构：- right atrium 右心房 - left atrium 左心房- right ventricle 右心室 - left ventricle 左心室- apex of the heart 心尖 - pericardium 心包3 Identify the following structures on a cross-section of the heart: 识别以下的心脏横截面结构：- right atrium 右心房 - mitral valve 二尖瓣- left atrium 左心房 - tricuspid valve 三尖瓣- right ventricle 右心室 - chordae tendineae 腱索- left ventricle 左心室 - papillary muscles 乳突肌- pulmonary valve 肺动脉瓣 - interventricular septum 室间膈- aortic valve 主动脉瓣4 Identify the anatomical functions of the following structures: 识别以下结构的解剖功能- right atrium 右心房 - aortic valve 主动脉瓣- left atrium 左心房 - mitral valve 二尖瓣 - right ventricle 右心室 - tricuspid valve 三尖瓣- left ventricle 左心室 - chordae tendineae 腱索- pulmonary valve 肺动脉瓣 - papillary muscles 乳突肌三Cardiac Cycle 心动周期Objectives目标1 Explain how the cardiac cycle relates to the ECG and hemodynamic waveform 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2Identify the phases of the cardiac cycle 识别心动周期的各个阶段3 Describe what is happening during each phase of the cardiac cycle 描述在每个心动周期阶段中发生什么四Determinants of Cardiac Output 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- cardiac output 心排量- cardiac index 心排指数- stroke volume 每搏量- stroke volume index 每搏指数- systemic vascular resistance 体循环阻力- pulmonary vascular resistance 肺循环阻力- left ventricular stroke work index 左心室每搏功指数- right ventricular stroke work index 右心室每搏指数- myocardial oxygen supply 心肌氧供应- myocardial oxygen demand 心肌氧需求2Identify the factors that affect 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- myocardial oxygen supply 心肌氧供应- myocardial oxygen demand 心肌氧需求Part 2 PRESSURE MONITORING第二部分 压力监测一Clinical Fundamentals 临床基本知识1 Components of Pressure Monitoring Systems 压力监测系统的组成 Electrical System 电子系统 Plumbing / Fluid System 冲刷/液体系统 Continuous flush device 连续冲刷装置 Pressure transducer 压力传感器 Pressure bag 压力包 IV solution (with or without heparin) 静脉输注液体(含或不含肝素)2Equipment set-up 系统设置 Set pressure scale in monitoring system 在监护系统上设置压力刻度 Assemble system and flush system with solution 装配系统并用液体冲刷系统 Set pressure bag to 300mmHg 将压力包加压到300mmHg Zeroing and referencing the catheter-tubing-transducer system 调零并定位导管管路传感器系统3Interference within the system 系统内部的干扰 Dynamic response 动力学反应 Frequency response 固有频率 Damping 衰减 Square waveform response 方波测试4Maintenance of System 系统维护 Issues with frequency of zeroing 调零的频率问题 Maintain pressure (300mmHg) within pressure bag 维持压力包内的压力 (300mmHg) Drawing blood samples 抽取血液样品5Where to take Readings of Pressure Measurements 在何处读取压力监测的读数 Effects of respiration (inhalation / exhalation) 呼吸的影响（吸气/呼气） Readings best taken at end-expiration 最好在呼气末期读取读数Spontaneous Breathing 自发呼吸 Mechanical Ventilation 机械通气6Problems that May Be Encountered Troubleshooting 可能遇到的问题故障排除 Damped waveform 衰减波形 Abnormally low or negative pressures 不正常的低压或者负压 Inability to wedge 无法契入 False high pressure readings 错误的高压力读数 Overwedging of PAW pressure tracing 过度契入的肺动脉契压波形 Catheter whip 导管漂移 Inability to flush / draw blood 无法冲刷/抽血7Arterial Pressure Monitoring 动脉压力监测 Purpose 目的 Sites 位点 Waveform 波形 Complications 并发症8Blood performs 2 main functions while circulating the Body 血液在体内循环时的2个主要功能9Factors that control blood pressure 控制血压的因素 Increased/decreased heart rate 心率增加/降低 Heart pumping too much/ too little blood心脏泵血过多/过少 Some organs are bypassed, i.e shock or after meals 某些器官分流，比如，休克或者进餐后 Thickening of arteries 动脉增厚 Constriction of arteries动脉收缩10. Typical Pressures and Values 典型的压力和数值 RIGHT HEART EMPTYING PRESSURE 右心排空压力 LEFT HEART FILLING PRESSURE 左心充盈压 PULMONARY ARTERY PRESSURE 肺动脉压 PAOP/PAWP 肺动脉阻断压/契压 RIGHT HEART FILLING PRESSURE 右心充盈压 LEFT HEART EMPTYING PRESSURE 左心排空压力 CENTRAL VENOUS PRESSURE 中心静脉压 ARTERIAL PRESSURE 动脉压11. Why measure pressures? 为什么测定压力？12Which products are traditionally used to access these pressure measurements?在测定上述压力时应用的传统产品是什么？Part 4 Hemodynamic Monitoring第四部分 血流动力学监测1The goal of the hemodynamic monitoring 血流动力学监测的目标2The purpose of hemodynamic monitoring 血流动力学监测的目的 Prevention 预防 Diagnosis 诊断 Management 管理3Cardiac Output 心排量 Definition 定义 Formula 公式 Normal Cardiac Output 正常心排量4Cardiac Index 心排指数 Definition 定义 Normal 正常值 Impact of heart rate 心率的影响 Bradyarrhythmias Tachyarrhythmias Stroke Volume 每搏量 Definition 定义 Determinants 决定因素 Preload 前负荷 Afterload 后负荷 Contractility 收缩力5Controversies surrounding the use of the Pulmonary Artery Catheter (PAC) 围绕肺动脉导管应用的争议 1996 the “Connors” study 1996年“Connors”研究 Practitioner knowledge regarding the use of hemodynamic parameters 执业医师对于血流动力学参数应用的知识 1996 SCCM PAC Conscensus Meeting 1996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 Outcome studies 结果研究 Pursuit of “non-invasive” technology: 追击“无创”技术 Bioimpedence cardiac output measurements 生物阻抗心排量测定 Transesophageal echocardiograms / 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. The Pulmonary Artery Catheter 肺动脉导管 Catheter Ports 导管端口 Proximal port 近端端口 VIP port VIP端口 Distal port Balloon port Thermistor Side port on Introducer Sheath7. Indications for Pulmonary Artery Pressure Monitoring 肺动脉压力监测的适应症8. Direct & Derived Parameters Associated with Hemodynamic Monitoring 和血流动力学监测相关的直接和衍生参数 Direct 直接 Derived Parameters 衍生参数9. Insertion of PAC 肺动脉导管插入 Insertion sites 插入位点 Insertion methods 插入方法 Observe for waveform changes during the insertion 在插入过程中观察波形的变化 Right Atrial Pressure 右心房压力 Purpose for Use 应用的目的 Normals 正常值 Neonate 新生儿 Child 儿童 Adult 成人 RA Waveform 右心房压力波形 Right Ventricle Pressure 右心室压力 Purpose for Use 应用的目的 Normals 正常值 Neonate 新生儿 Child 儿童 Adult 成人 RV Waveform 右心室波形 Pulmonary Artery Pressure 肺动脉压 Purpose for Use 应用的目的 PA systolic pressure 肺动脉收缩压 PA diastolic pressure 肺动脉舒张压 PA mean pressure (PAM) 肺动脉平均压 Pulmonary Artery Wedge Pressure (Pawp/Paop) Assumptions 假设 Inflation volume 球囊充盈容量 Normals 正常值 Neonate 新生儿 Child 儿童 Adult 成人 Waveform 波形 Catheter Maintenance 导管维护 Problems with PA catheters / lines 肺动脉导管/线路使用的问题10DERIVED PARAMETERS 衍生参数 Mean Arterial Pressure 平均动脉压 Formula公式 Normal正常值 Definition 定义 Causes of increased MAP 平均动脉压增高的原因 Causes of decreased MAP 平均动脉压降低的原因 Mean Pulmonary Artery Press