重症监护产品知识概要指南

欢迎阅读本文档，希望本文档能对您有所帮助!欢迎阅读本文档，希望本文档能对您有所帮助!感谢阅读本文档，希望本文档能对您有所帮助!感谢阅读本文档，希望本文档能对您有所帮助!欢迎阅读本文档，希望本文档能对您有所帮助!感谢阅读本文档，希望本文档能对您有所帮助!GuidelinesofCriticalCareProductKnowledgeRequirementPart1AnatomyandPhysiology第一部分解剖和生理一．VascularAnatomy血管解剖Objectives目标1．Describethepurposeofthevascularsystem描述血管系统的用途2．Identifythemainstructuresofthethoraciccavity识别胸腔的主要结构3．Identifythefollowingarteriesandveinsinthethoraciccavity:识别在胸腔中的以下动脉和静脉ArteryVein动脉静脉-aorticarch主动脉弓-inferiorvenacava上腔静脉-ascendingaorta升主动脉-superiorvenacava下腔静脉-descendingthoracicaorta降主动脉-brachiocephalic(innominate)头臂动脉（无名动脉）-leftmaincoronary左主冠脉-leftsubclavian左锁骨下动脉-pulmonary肺动脉-rightcoronary右冠脉-rightsubclavian右锁骨下动脉4．Identifythefollowingarteriesandveinsinthevascularsystem:识别以下的血管系统的动脉和静脉ArteryVein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-renalarteries肾动脉-renalveins肾静脉-abdominalaorta腹主动脉-axillary腋静脉-descendingthoracicaorta降主动脉-cephalic头静脉-externalcarotid颈外动脉-externaljugular颈外静脉-internalcarotid颈内动脉-internaljugular颈内静脉-leftcommoncarotid左颈总动脉-saphenous大隐静脉-radial桡动脉-subclavian锁骨下静脉-posteriortibial胫后动脉-ulnarartery尺动脉-vertebral椎动脉-dorsalispedis足背动脉二．CardiacAnatomy心脏解剖Objectives目标1．Describethepurposeoftheheart描述心脏的用途2．Identifythefollowingstructuresinthethoraciccavity: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：-rightatrium右心房-mitralvalve二尖瓣-leftatrium左心房-tricuspidvalve三尖瓣-rightventricle右心室-chordaetendineae腱索-leftventricle左心室-papillarymuscles乳突肌-pulmonaryvalve肺动脉瓣-interventricularseptum室间膈aorticvalve主动脉瓣4．Identifytheanatomicalfunctionsofthefollowingstructures:识别以下结构的解剖功能-rightatrium右心房-aorticvalve主动脉瓣-leftatrium左心房-mitralvalve二尖瓣-rightventricle右心室-tricuspidvalve三尖瓣-leftventricle左心室-chordaetendineae腱索-pulmonaryvalve肺动脉瓣-papillarymuscles乳突肌三．CardiacCycle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．Describewhatishappeningduringeachphaseofthecardiaccycle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1．Define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-leftventricularstrokeworkindex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2．Identifythefactorsthataffect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第二部分压力监测一．ClinicalFundamentals临床基本知识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300mmHgZeroingandreferencingthecatheter-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．MaintenanceofSystem系统维护Issueswithfrequencyofzeroing调零的频率问题Maintainpressure(300mmHg)withinpressurebag维持压力包内的压力(300mmHg)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－SpontaneousBreathing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/drawblood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 Someorgansarebypassed,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RightHeartEmptyingpressure右心排空压力LeftHeartFillingPressure左心充盈压PulmonaryArteryPressure肺动脉压PAOP/PAWP肺动脉阻断压/契压RightHeartFillingPressure右心充盈压LeftHeartEmptyingPressure左心排空压力CentralVenousPressure中心静脉压ArterialPressure动脉压11.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BradyarrhythmiasTachyarrhythmiasStrokeVolume每搏量Definition定义Determinants决定因素Preload前负荷Afterload后负荷Contractility收缩力5．ControversiessurroundingtheuseofthePulmonaryArteryCatheter(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”technology:追击“无创”技术Bioimpedencecardiacoutputmeasurements生物阻抗心排量测定Transesophagealechocardiograms/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DistalportBalloonportThermistorSideportonIntroducerSheath7.IndicationsforPulmonaryArteryPressureMonitoring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RightAtrialPressure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(PAM)肺动脉平均压PulmonaryArteryWedgePressure(Pawp/Paop)Assumptions假设Inflationvolume球囊充盈容量Normals正常值Neonate新生儿Child儿童Adult成人Waveform波形CatheterMaintenance导管维护ProblemswithPAcatheters/lines肺动脉导管/线路使用的问题10．DerivedParameters衍生参数MeanArterialPressu