漂浮导管的临床应用复习进程课件

漂浮导管的临床应用Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL肺动脉楔压(PAWP)PulmonaryLeftArteryAtrialVentricularVentriculaIWedgePressureEnd.EndPressureastolicastonPressureVolumeAirwayMitralDiseaseValveVentricularCompliance①反映肺部的循环状态。在通常的呼吸和循环下,肺动脉楔压基本上与肺静脉致,能正确反映肺循环的扩张或充盈压。②肺动脉楔压与左心房平均压密切相关,一般不高于后者1~2mmHg③肺动脉楔压的正确和连续观测是判断肺淤血及其程度较有价值的指标。Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLpening(Ports,&家hCatheterValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLSwan-Gan导管监测所需仪器设备导曾测压装置如果连续测定PAP,间断测RAP,可准备一套长期的测厌装置。如果要连续监压力力如压,则必需准备两套。测压装置包括加20~30mg)、输液装热铀电阳接个装置度持续冲洗不影响压力监测,又可以快速冲洗导现在已有一次性使用的能网哥Evaluatononly.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL常用右颈内静脉穿刺点(次选左锁骨下)Valadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLCatheterentranceCatheterAortaSuperiorvenacavaPulmonaryLeftRightalumatriaPulmonaryTricuspid-valveLeftventriclevenacavaRightventricleWADAMValadononry.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLSwan-Ganz导管的放置置入Swan-Ganz导管之前,先按程序准备好压力监测装置调整传感器者心脏的中部水平或腋中线装置内所有气体。将导管黄色末端测压装置相联,边看压力边进管丫一旦导管尖端出了鞘管(约15cm),到达上腔静脉和右房连接部,将气囊充气,锁闭导管阀门(7遇有阻力时不能强行打气。如疑有心内分流,应选用CO2充盈避免气破裂时而发生体循环空气栓塞。导管深度般成人)颈静脉15~25cm肘前静脉40~50cm锁骨下静脉10~15cm股静脉30cmEvaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyLSystolicRightatrialpressureHightventricularpressurePulmonaryarterypressurePulmonaryartery0-8mmHgstoic:20-30mmHgSystolic:20-30mmHgwedgepressureDiastolic:8-15mmHEvaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL右颈内静脉置管距穿刺点距离距离压力右心房15~25cm0~6mmH右心室25--35cmS15-25mmHgdo8mmhg肺动脉40-45cms1525mmHgd815mmHg肺动脉楔压约50cm6~12mmHgY监测波形胸部X线Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2019-2019AsposePtyL中心静脉压=右心房压力ECGSystole1DiastoleCVP波形成分心动周期时间机械活动a波(atrial)舒张期末心房收缩c波(ontraction))收缩早期心室等容收缩,三尖瓣移向右心房lw波(venous,)收缩后期心房充盈Evaluauon