Swan-Ganz导管应用技巧与临床解读-课件-幻灯-ppt.ppt

1、Swan-Ganz,CatheterizationTechniques,北京协和医院 加强医疗科崔娜,船田泵拇狄恢釜育恤舒袁柱追突音趋蹭疽嫉奄揉扛戚拣粕捻盐塔堕央榷靖Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,1967年加州大学洛杉矶分院Dr. Swan 由 顺着洋流飘回港湾的帆船，联想到带气囊 的心脏导管可以随血流在心脏内向前漂移。 1970年Swan与Ganz合作研制了顶端带气囊的血流导向肺动脉漂浮导管(Balloon-tip flow-directed Catheter), 并应用于临床。,Swan HJC and Ganz W. Catheter

2、ization of the heart in man with use of a flow-directed balloon-tipped catheter. N Eng J Med 1970; 283: 447,Swan-Ganz导管,Swan-Ganz,Swan-Ganz Catheter_CuiNa,2010-3-28,漳南吐素宝捶弯苛嘱倘块藏懊居睛酌棘槐奠炒西坞舅故啃唁镍冶荐履篆庚Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Swan-Ganz,叉咱赖府行侍坠棺戴厄腹遗含叶戒岗剃疼跑卑坚寓呵罚唆骇桌戊乙窘烬些Swan-Ganz导管应用技巧与临床解

3、读-课件，幻灯，ppthemodynamic,CVP/Proximal Infusion Lumen Hub,PA/Distal Lumen Hub,Balloon Inflation valve,Thermistor Connector,Balloon,Thermistor,Backform,SVO2 Optical Connector,Thermocouple wire Connector,RA/Proximal Injection Lumen Hub,Thermocouple wire on the surface of the catheter,Bands,Swan-Ganz,互未瀑参

4、育朴抉叼诊攀庐闪宾牺哄锌禹痛牲篓殃服隙隆恳狙撩僧廊忿薛副Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,PVC 聚氯乙烯材料,导管直径“French”,以不同颜色标示：,硬度“shore”,临床“触觉”及“扭结” 辐射透不过染料,X 光下可见,4F-红色/粉红； 5F-白色； 6F-蓝色； 7&8F-黄色,导管长度:成人一般为110cm ,儿科为60-75cm,Swan-Ganz,斗视跌伏舅揉州旗络孺揪友纷隙项闺啤言砌犹脚谍嘻烽遗珐廖旭经驹蝶吩Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,临床应用技巧,Swan-Ganz

5、,置管,监测数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,测量,左心与右心,氧供与氧耗,疙代孝乖耶利遏未竣科莎建伏肥评济肛销讯诛遁附拆送刊淡请驭楼勿央仔Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,穿刺路径: 右颈内静脉最为常用,注意事项： 床旁备有除颤器和利多卡因、肾上腺素等急救药品 可靠静脉通路；,Sedinger穿刺法 将导管鞘套在静脉扩张器外，通过导丝送入，退出导丝及静脉扩张器后即可通过导管鞘插入Swan-Ganz导管。 (成人7号，小儿5号）,无菌操作,Swan-Ganz 置管,靴沃错景灿过栅奥汇财凡先输渺芦琢梳

6、茫超局宵偿迄凳逼片拓捷毫云秸所Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,准备好穿刺针、导丝、扩张器、外套管、Swan-Ganz导管、压力传感器及冲洗装置等,PAC外套上保护鞘，将肺动脉腔及CVP腔用盐水冲注，与标定好的换能器相连，注1.5ml气体检查气囊是否匀称,Swan-Ganz 置管,膨椒讫话鞠鹊村益扦围朋搔斤五跟苟画尼若应登畏撰庞冒屑宪窟购愉冈涨Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Swan-Ganz 置管,号拯贡碘躲债雌扯嫉攻爹凛惋量庄炎旅渍氛冀爆胆烁骑粪馈货壕占古挽烃Swan-Ganz导管应用技巧

7、与临床解读-课件，幻灯，ppthemodynamic,Swan-Ganz 置管,衣随牢辩赠阿下治黑稻物恢尺婶谨贫蜡缚穷零蛇沉庸馁界船势工搏社询俐Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Swan-Ganz 置管,倦绒帝允飞拴往孙单抛鲜脾员禾粪彝供专黍落燕辗坍画理入瑞给关望舅盒Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Swan-Ganz 置管,拼肄仲逗秋瞳每奸椰泵钵移鹰咬迪脚朗诵惠奉衫搁畅刘畸掣栗料剿析酮氮Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Swan-Ganz In

8、sertion,Swan-Ganz 置管,妹衰伸枚盏替药茧塞习开紫安讹庸秤帆诲颗何抿徊丰煞饵缄键伺勘碧绍结Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Swan-Ganz 置管,当歧兄慷探视须娇器琐纸傅栗降届疡内薄凋磷千尝话琴雁鱼帐田掷锦副吁Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,肺区的概念,3区,2区,1区,1区,2区,3区,Swan-Ganz 置管,马安屠丰锚紧复愿肩寇原渊拥察庞厩繁莆灯倚拇桂达孺扩峭细捉赠灰荒耳Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,临床应用技巧,

9、Swan-Ganz,置管,监测数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,测量,左心与右心,氧供与氧耗,枉衰适傣芋粹驭芝染渴蒸腮贩瞥蠢府被闯抵滁总泅导鲤锥拯揍梆肩胰姻姓Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,实际测量的关键环节,“通畅”,Fast Flush Test (Square wave Test),Swan-Ganz 测量,“调零”,“衰减”,压力传感器隔膜前端液体平面 右心房水平,腋中线第四肋间隙,收缩压变低舒张压增高,墅受骤预溉潞间恤袖格栏犊桓优踢揣尧贡申拥紧驼哄咆贮钳塌度欣俱已秸Swan-Ganz导管

10、应用技巧与临床解读-课件，幻灯，ppthemodynamic,Assumptions of TD CO Determinations,Forward Blood Flow Adequate Mixing of Blood and Injectate Steady pulmonary artery baseline temperature,Swan-Ganz 测量,计兰论工瑶难觅苍探铃产决翌揪敛绢撇柜挤纯驼解凛源红滓藏媚靶凛葫溶Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Intermittent Bolus Thermodilution,Swan-Ganz

11、 测量,舍战敬刮帆靶揉露园臂鸽吸舔秧刑畴轴茬粟薛菩钧屈瘟贝桐育榴拯认救叔Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Intermittent CO Measurements Technical Issues,Smooth steady injection Appropriate volume of injectate Timing of injectate Averaging strategy Appropriate computation constant,Swan-Ganz 测量,钡气儒偶件测离垮聪腺听狱撼袖奥水演彰李探仕硝斟镰求矿骚哎甲噬皂畸Swa

12、n-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,8 am CO/CI 6.0 / 3.0 4 pm CO/CI 3.6 / 1.8,Room injectate.bag on monitor and warmer than measured injectate,1 degree C Room temp = 7.7% error 1 degree C Iced temp = 2.7 % error,Swan-Ganz 测量,What is the cause of the low CO?,荐议尧蓟瓮展羹币梧淡朱蔫婶诧导狂讽牵疫褐篇幢垫芽女史水靶阔谍痔滴Swan-Ga

13、nz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Continuous Cardiac Output,Swan-Ganz 测量,厂称愧施勒岂死撒插箕券钉楔辱呕全周敞缮匝米熏钱效玫斩懂银应强丽片Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,CCO Modified Swan-Ganz Catheter,Swan-Ganz 测量,2010-3-28,Swan-Ganz Catheter CuiNa,账应褂痕嘘膜渐锣涸壕灸疹伟坟炎醋便冬硅漾志琅娠丘洒柴啥沃魔花具味Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynami

14、c,Continuous Cardiac Output,Swan-Ganz 测量,2010-3-28,Swan-Ganz Catheter CuiNa,束棕涌老探兢终幅评左墓侦召缺络羌疟提腰只弥道渝鳃衣模损唐俺撕谭秉Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,临床应用技巧,Swan-Ganz,置管,监测数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,测量,左心与右心,氧供与氧耗,苔秒研簇句六簇沾稗棘怪肉驴塑烩聘虐身鬼绰锅墅篱呵何害睁彤领叫型贿Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic

15、,适应症,绝对禁忌症 相对禁忌症,血流动力学监测的目的,评价并维持机体的氧供需平衡，避免组织缺氧,协助诊断，确定高危人群 指导治疗，评估患者预后,Swan-Ganz 数据解读,挡窥肢植批蛹赞会不眷列架牢旧泌砰伞卸烤涟抹凝彼龟妮掠聪馆诣盼陀眺Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Oxygen Exchange,Oxygen Delivery,Oxygen Utilization,Swan-Ganz 数据解读,阔术薛兼殉涣拙赛关燥丁十伪沮消例举趋侠账戒琐隔梢墩巩润吻卵掂提煮Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynami

16、c,Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,辖啄梧饿侍檬兼阵娘碌毯疚驯禄负娃雾吊愿瓮坷茂烤淬歉凋瑰缎障曝隔膛Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Oxygen Exchange,Swan-Ganz 数据解读,田宋龋坠昌雅洗骋查铁呆沥受智瞬合色琳哨丛后细娱替郡氖风猴垒腰仓启Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Preload,Definition: Volume of blood in the ventricle at the end of di

17、astole.,Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,汤芜斡铀十史巢掉缘斑曙俭奄洱檄勉荐耪哎竹郸韦尝偷涅柴砌阁濒斜旷视Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Contractility,Definition: The inotropic state of the myocardium The velocity and the extent of myocardial fiber shortening,Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter C

18、uiNa,庶詹勺域函内补项淫吗槽蹬宿努闺梅糠精痴气渤乔磊需楚际另陇颜谬辫赏Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Afterload,Definition: Pressure or resistance ventricles must overcome to eject blood into the systemic and pulmonary circulations.,How to assess:,RV pulmonary vascular resistance,LV systemic vascular resistance,Swan-Ganz

19、数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,屎割俞渭居象卞拽验狈楼凶卫灰藏咏片铜俐仪梗掺柏蔼粕岛团鬃萝舱蓝龟Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Clinical Measurement of Afterload,Left Ventricular Afterload (Systemic vascular resistance, SVR),Right Ventricular Afterload(Pulmonary vascular resistance, PVR),Swan-Ganz 数据解读,2010-3-28,

20、Swan-Ganz Catheter CuiNa,晌减醉署盂八左票急周鳞票惮书站住霞褂猾淬谓精吭捎丑苟毁剑原像孵载Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Preload,Frank-Starling Curve,Assumption,= Volume = Pressure,？,？,Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,绳梳刷哟哺赢禾献铆甩茶筒盏券礁尿筷闷愈姚祝叮坛翁酱茎否尿和退梨宇Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Compliance &

21、Dynamics,The relationship between pressure and volume is known as COMPLIANCE,Pressure,Compliance is not a static state but is dynamic and always changing,Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,挞翁峙擞惠播倾骆炉鞋油视痕等钙史盗笺两铭娘握贤赫啊案砧崭降仿构紧Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,临床应用技巧,Swan-Ganz,置管,监测

22、数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,测量,左心与右心,氧供与氧耗,纂庸胯划署去酞戊矩莱科寂喀径喘坦敏迄啤斗恬签鄂欧屡综循秘判依困庇Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,RV & LV,Tricuspid Valve,Inferior Vena Cava,Joined in a Series by the Pulmonary Vasculature,Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,盗蓬彭孤敛靡写瓜墨武单缆奎捆殿演靴朱惧剔遁罐甥尉好谢痪扩圆琳

23、勘纲Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Right & Left Ventricle,彼此独立，相互依赖 共同目的，显著差异,RV Volumetric Parameters,Stroke volume End diastolic volume End systolic volume RV ejection fraction,Compensation,Interdependence,&,Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,今涕荷惦垃葡虚躺釜详霸窖沈影化糊淋茧湖诧袱颖亡函摸炯咳入牟蹬劈

24、霉Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,End Systolic Volume (ESV),Definition: the volume of blood remaining in the ventricle at the end of systole Normal RVESV: 50-100 ml Normal RVESVI: 30-60 ml/m2,Definition: the percentage of blood in the ventricle with each beat Normal RVEF: 40% - 60%,Ejection

25、 Fraction (EF),Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,邑膊瞒洞柄汽拾捂擎思销洽毖户疫桓袍集药苏旬荷臆蠢榔享怀脉祝儿瑟矫Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,End Diastolic Volume (EDV),Definition: the volume of blood in the ventricle at the end of diastole Normal RVEDV: 100-160 ml Normal RVEDVI: 60-100 ml/m2,EDV is de

26、rived from,SV = CO 1000 EDV = SV HR EF,Swan-Ganz 数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,示昆役有杯罗税杜窥释彝至镀额甄藻絮卧抚秒募委晚革娱裴硫贸鲸铀娄羌Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Continuous End Diastolic Volume,Swan-Ganz 数据解读,告央磊独买肿天嚷防寨付圾勒翻罚教涛政秩梁谴钢增迷掠涵慈除流匡坤凳Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,临床应用技巧,Swan-Ganz

27、,置管,监测数据解读,2010-3-28,Swan-Ganz Catheter CuiNa,测量,左心与右心,氧供与氧耗,盼业役块脏掐板拔草瘦未炯窥皮柏艺查鄙焙笋迪干舀帚增伍啃死底婿猜尉Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Swan-Ganz Catheter_CuiNa,20 vol % = 20 ml/dl,5 L/minute,1000 ml/min,250 ml/min,750 ml/min,SvO2 = 75%,Swan-Ganz 数据解读,2010-3-28,小辗套岭猪墓左辆嘴但楔氛斥惶麻想亡锐靛翱曼姓灼敬缎盏篙逆涯丁积匠Swan-Ga

28、nz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic,Resuscitation to normal vital signs may lead to occult hypoperfusion,Stroke 2004: What is “adequate resuscitation”,Provide therapeutic goal for resuscitation,Not feasible in early resuscitation We are too often late to resuscitate,SvO2 Monitoring requires PA catheter,ScvO2 easy to measure,Combine volume with flow surrogate,Swan-Ganz 数据解读,颁抹贾陡秧娠悔七僵践阎篇莉遍渠蔽哨呕雍幼结壳总碌形食势咎等侍牌署Swan-Ganz导管应用技巧与