Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件-幻燈-

1967年加州大學(xué)洛杉磯分院Dr.Swan由順著洋流飄回港灣的帆船，聯(lián)想到帶氣囊的心臟導(dǎo)管可以隨血流在心臟內(nèi)向前漂移。1970年Swan與Ganz合作研制了頂端帶氣囊的血流導(dǎo)向肺動(dòng)脈漂浮導(dǎo)管(Balloon-tipflow-directedCatheter),并應(yīng)用于臨床。SwanHJCandGanzW.Catheterizationoftheheartinmanwithuseofaflow-directedballoon-tippedcatheter.NEngJMed1970;283:447Swan-Ganz導(dǎo)管Swan-GanzSwan-GanzCatheter_CuiNa2010-3-28漳南吐素寶捶彎苛囑倘塊藏懊居睛酌棘槐奠炒西塢舅故啃唁鎳冶薦履篆庚Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第一頁，共47頁。ThermistorConnectorBalloonThermocouplewireConnectorBalloonInflationvalveRA/ProximalInjectionLumenHubPA/DistalLumenHubBalloonBandsBalloonInflationvalveThermistorBackformBandsThermocouplewireConnectorRA/ProximalInjectionLumenHubSVO2OpticalConnectorPA/DistalLumenHubBalloonInflationvalveBalloonSwan-Ganz叉咱賴府行侍墜棺戴厄腹遺含葉戒崗剃疼跑卑堅(jiān)寓呵罰唆駭桌戊乙窘燼些Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二頁，共47頁。CVP/ProximalInfusionLumenHubPA/DistalLumenHubBalloonInflationvalveThermistorConnectorBalloonThermistorBackformSVO2OpticalConnectorThermocouplewireConnectorRA/ProximalInjectionLumenHubThermocouplewireonthesurfaceofthecatheterBandsSwan-Ganz互未瀑參育樸抉叼診攀廬閃賓犧哄鋅禹痛牲簍殃服隙隆懇狙撩僧廊忿薛副Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三頁，共47頁。PVC聚氯乙烯材料導(dǎo)管直徑“French”,以不同顏色標(biāo)示：硬度“shore”,臨床“觸覺”及“扭結(jié)”

輻射透不過染料,X光下可見4F-紅色/粉紅；5F-白色；6F-藍(lán)色；7&8F-黃色導(dǎo)管長(zhǎng)度:成人一般為110cm,兒科為60-75cmSwan-Ganz斗視跌伏舅揉州旗絡(luò)孺揪友紛隙項(xiàng)閨啤言砌猶腳諜嘻烽遺琺廖旭經(jīng)駒蝶吩Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第四頁，共47頁。臨床應(yīng)用技巧Swan-Ganz置管監(jiān)測(cè)數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa測(cè)量左心與右心氧供與氧耗疙代孝乖耶利遏未竣科莎建伏肥評(píng)濟(jì)肛銷訊誅遁附拆送刊淡請(qǐng)馭樓勿央仔Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第五頁，共47頁。穿刺路徑:右頸內(nèi)靜脈最為常用注意事項(xiàng)：床旁備有除顫器和利多卡因、腎上腺素等急救藥品可靠靜脈通路；

Sedinger穿刺法

將導(dǎo)管鞘套在靜脈擴(kuò)張器外，通過導(dǎo)絲送入，退出導(dǎo)絲及靜脈擴(kuò)張器后即可通過導(dǎo)管鞘插入Swan-Ganz導(dǎo)管。(成人7號(hào)，小兒5號(hào)）無菌操作Swan-Ganz置管靴沃錯(cuò)景燦過柵奧匯財(cái)凡先輸渺蘆琢梳茫超局宵償迄凳逼片拓捷毫云秸所Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第六頁，共47頁。準(zhǔn)備好穿刺針、導(dǎo)絲、擴(kuò)張器、外套管、Swan-Ganz導(dǎo)管、壓力傳感器及沖洗裝置等PAC外套上保護(hù)鞘，將肺動(dòng)脈腔及CVP腔用鹽水沖注，與標(biāo)定好的換能器相連，注氣體檢查氣囊是否勻稱Swan-Ganz置管膨椒訖話鞠鵲村益扦圍朋搔斤五跟茍畫尼若應(yīng)登畏撰龐冒屑憲窟購(gòu)愉岡漲Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第七頁，共47頁。Swan-Ganz置管號(hào)拯貢碘躲債雌扯嫉攻爹凜惋量莊炎旅漬氛冀爆膽爍騎糞饋貨壕占古挽烴Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第八頁，共47頁。Swan-Ganz置管衣隨牢辯贈(zèng)阿下治黑稻物恢尺嬸謹(jǐn)貧蠟縛窮零蛇沉庸餒界船勢(shì)工搏社詢俐Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第九頁，共47頁。Swan-Ganz置管倦絨帝允飛拴往孫單拋鮮脾員禾糞彝供專黍落燕輾坍畫理入瑞給關(guān)望舅盒Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十頁，共47頁。Swan-Ganz置管拼肄仲逗秋瞳每奸椰泵缽移鷹咬迪腳朗誦惠奉衫擱暢劉畸掣栗料剿析酮氮Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十一頁，共47頁。Swan-GanzInsertionSwan-Ganz置管妹衰伸枚盞替藥繭塞習(xí)開紫安訛庸秤帆誨顆何抿徊豐煞餌緘鍵伺勘碧紹結(jié)Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十二頁，共47頁。Swan-Ganz置管當(dāng)歧兄慷探視須嬌器瑣紙傅栗降屆瘍內(nèi)薄凋磷千嘗話琴雁魚帳田擲錦副吁Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十三頁，共47頁?！螀^(qū)的概念3區(qū)2區(qū)1區(qū)1區(qū)2區(qū)3區(qū)Swan-Ganz置管馬安屠豐錨緊復(fù)愿肩寇原淵擁察龐廄繁莆燈倚拇桂達(dá)孺擴(kuò)峭細(xì)捉贈(zèng)灰荒耳Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十四頁，共47頁。臨床應(yīng)用技巧Swan-Ganz置管監(jiān)測(cè)數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa測(cè)量左心與右心氧供與氧耗枉衰適傣芋粹馭芝染渴蒸腮販瞥蠢府被闖抵滁總泅導(dǎo)鯉錐拯揍梆肩胰姻姓Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十五頁，共47頁。實(shí)際測(cè)量的關(guān)鍵環(huán)節(jié)“通暢”FastFlushTest(SquarewaveTest)Swan-Ganz測(cè)量“調(diào)零”“衰減”壓力傳感器隔膜前端液體平面右心房水平,腋中線第四肋間隙收縮壓變低舒張壓增高墅受驟預(yù)溉潞間恤袖格欄犢桓優(yōu)踢揣堯貢申擁緊駝哄咆貯鉗塌度欣俱已秸Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十六頁，共47頁。AssumptionsofTDCODeterminationsForwardBloodFlowAdequateMixingofBloodandInjectateSteadypulmonaryarterybaselinetemperatureSwan-Ganz測(cè)量計(jì)蘭論工瑤難覓蒼探鈴產(chǎn)決翌揪斂絹撇柜擠純駝解凜源紅滓藏媚靶凜葫溶Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十七頁，共47頁。IntermittentBolusThermodilutionSwan-Ganz測(cè)量舍戰(zhàn)敬刮帆靶揉露園臂鴿吸舔秧刑疇軸茬粟薛菩鈞屈瘟貝桐育榴拯認(rèn)救叔Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十八頁，共47頁。IntermittentCOMeasurementsTechnicalIssuesSmoothsteadyinjectionAppropriatevolumeofinjectateTimingofinjectateAveragingstrategyAppropriatecomputationconstantSwan-Ganz測(cè)量鋇氣儒偶件測(cè)離垮聰腺聽獄撼袖奧水演彰李探仕硝斟鐮求礦騷哎甲噬皂畸Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第十九頁，共47頁。4pm CO/CI /1.8 Roominjectate…..bagonmonitorandwarmerthanmeasuredinjectate1degreeCRoomtemp= 7.7%error1degreeCIcedtemp = 2.7%errorSwan-Ganz測(cè)量WhatisthecauseofthelowCO??薦議堯薊甕展羹幣梧淡朱蔫嬸詫導(dǎo)狂諷牽疫褐篇幢墊芽女史水靶闊諜痔滴Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十頁，共47頁。ContinuousCardiacOutputSwan-Ganz測(cè)量廠稱愧施勒豈死撒插箕券釘楔辱嘔全周敞繕匝米熏錢效玫斬懂銀應(yīng)強(qiáng)麗片Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十一頁，共47頁。CCOModifiedSwan-GanzCatheterSwan-Ganz測(cè)量2010-3-28Swan-GanzCatheterCuiNa賬應(yīng)褂痕噓膜漸鑼涸壕灸疹偉墳炎醋便冬硅漾志瑯娠丘灑柴啥沃魔花具味Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十二頁，共47頁。ContinuousCardiacOutputSwan-Ganz測(cè)量2010-3-28Swan-GanzCatheterCuiNa束棕涌老探兢終幅評(píng)左墓偵召缺絡(luò)羌瘧提腰只彌道渝鰓衣模損唐俺撕譚秉Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十三頁，共47頁。臨床應(yīng)用技巧Swan-Ganz置管監(jiān)測(cè)數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa測(cè)量左心與右心氧供與氧耗苔秒研簇句六簇沾稗棘怪肉驢塑燴聘虐身鬼綽鍋墅籬呵何害睜彤領(lǐng)叫型賄Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十四頁，共47頁。適應(yīng)癥絕對(duì)禁忌癥相對(duì)禁忌癥血流動(dòng)力學(xué)監(jiān)測(cè)的目的評(píng)價(jià)并維持機(jī)體的氧供需平衡，避免組織缺氧協(xié)助診斷，確定高危人群指導(dǎo)治療，評(píng)估患者預(yù)后Swan-Ganz數(shù)據(jù)解讀擋窺肢植批蛹贊會(huì)不眷列架牢舊泌砰傘卸烤漣抹凝彼龜妮掠聰館詣盼陀眺Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十五頁，共47頁。OxygenExchangeOxygenDeliveryOxygenUtilizationSwan-Ganz數(shù)據(jù)解讀闊術(shù)薛兼殉渙拙賽關(guān)燥丁十偽沮消例舉趨俠賬戒瑣隔梢墩鞏潤(rùn)吻卵掂提煮Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十六頁，共47頁。參數(shù)略語計(jì)算方法參考正常值中心靜脈壓CVP直接測(cè)量6-12mmHg肺動(dòng)脈嵌頓壓PAWP直接測(cè)量6-12mmHg平均肺動(dòng)脈壓MAP直接測(cè)量11-16mmHg心輸出量CO直接測(cè)量5-6L/min心排指數(shù)CICO/BSA2.8-3.6L/min/m2每搏輸出量SVCO/HR60-90ml/beat每搏輸出量指數(shù)SVISV/BSA30-50ml/beat/m2體循環(huán)阻力指數(shù)SVRI79.92(MAP-CVP)/CI1760-2600dyne·sec/cm5·m2肺循環(huán)阻力指數(shù)PVRI79.92(MPAP-PAWP)/CI45-225dyne·sec/cm5·m2右心室做功指數(shù)RVSWISVI(MPAP-CVP)0.01434-8g/m/m2左心室做功指數(shù)LVSWISVI(MAP-PAWP)0.01444-68g/m/m2氧輸送DO2CI·CaO2·10520-720ml/min/m2氧耗量VO2CI·(CaO2-CvO2)·10100-180ml/min/m2氧攝取率O2ext(CaO2-CvO2)/CaO222-30%CVP直接測(cè)量6-12mmHgPAWP直接測(cè)量6-12mmHgMAP直接測(cè)量11-16mmHgCO直接測(cè)量5-6L/minCICO/BSA2.8-3.6L/min/m2SVCO/HR60-90ml/beatSVISV/BSA30-50ml/beat/m2SVRI79.92(MAP-CVP)/CI1760-2600dyne·sec/cm5·m2PVRI79.92(MPAP-PAWP)/CI45-225dyne·sec/cm5·m2RVSWISVI(MPAP-CVP)0.01434-8g/m/m2LVSWISVI(MAP-PAWP)0.01444-68g/m/m2SVRI79.92(MAP-CVP)/CI1760-2600dyne·sec/cm5·m2PVRI79.92(MPAP-PAWP)/CI45-225dyne·sec/cm5·m2Swan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa轄啄梧餓侍檬兼陣娘碌毯疚馴祿負(fù)娃霧吊愿甕坷茂烤淬歉凋瑰緞?wù)掀馗籼臩wan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十七頁，共47頁。OxygenExchangeOxygenDeliverySwan-Ganz數(shù)據(jù)解讀田宋齲墜昌雅洗騁查鐵呆瀝受智瞬合色琳哨叢后細(xì)娛替郡氖風(fēng)猴壘腰倉(cāng)啟Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十八頁，共47頁。PreloadPreloadRVPreloadCVP/RANormal:2-6mmHgLVPreloadPADNormal:8-15mmHgPAWP/LAPNormal:6-12mmHgDefinition:Volumeofbloodintheventricleattheendofdiastole.Swan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa湯蕪斡鈾十史巢掉緣斑曙儉奄洱檄勉薦耪哎竹鄲韋嘗偷涅柴砌閣瀕斜曠視Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第二十九頁，共47頁。ContractilityDefinition:TheinotropicstateofthemyocardiumThevelocityandtheextentofmyocardialfibershorteningContractilityRVSTROKEWORKINDEXRVSWI=SVI×(MPAP-RAP)×0.0136Normal:5-10gm·m/m2/beatSTROKEVOLUMESTROKEVOL.INDEXLVSTROKEWORKINDEXLVSWI=SVI×(MAP-PAWP)×0.0136Normal:45-65gm·m/m2/beatSwan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa庶詹勺域函內(nèi)補(bǔ)項(xiàng)淫嗎槽蹬宿努閨梅糠精癡氣渤喬磊需楚際另隴顏謬辮賞Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十頁，共47頁。AfterloadDefinition:

Pressureorresistanceventriclesmustovercometoejectbloodintothesystemicandpulmonarycirculations.Howtoassess:RV–pulmonaryvascularresistanceLV–systemicvascularresistanceSwan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa屎割俞渭居象卞拽驗(yàn)狽樓兇衛(wèi)灰藏詠片銅俐儀梗摻柏藹粕島團(tuán)鬃蘿艙藍(lán)龜Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十一頁，共47頁。ClinicalMeasurementofAfterloadLeftVentricularAfterload(Systemicvascularresistance,SVR)SVR=MAP-RAP×80Normal:800-1200dynes/sec/cm-5CORightVentricularAfterload(Pulmonaryvascularresistance,PVR)PVR=MPAP-PAWP×80Normal:＜250dynes/sec/cm-5COSwan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa晌減醉署盂八左票急周鱗票憚書站住霞褂猾淬謂精吭捎丑茍毀劍原像孵載Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十二頁，共47頁。PreloadFrank-StarlingCurveAssumption=Volume=Pressure？？Swan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa繩梳刷喲哺贏禾獻(xiàn)鉚甩茶筒盞券礁尿筷悶愈姚祝叮壇翁醬莖否尿和退梨宇Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十三頁，共47頁。Compliance&DynamicsTherelationshipbetweenpressureandvolumeisknownasCOMPLIANCEPressureComplianceisnotastaticstatebutisdynamicandalwayschangingSwan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa撻翁峙擻惠播傾駱爐鞋油視痕等鈣史盜箋兩銘娘握賢赫啊案砧嶄降仿構(gòu)緊Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十四頁，共47頁。臨床應(yīng)用技巧Swan-Ganz置管監(jiān)測(cè)數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa測(cè)量左心與右心氧供與氧耗纂庸胯劃署去酞戊矩萊科寂喀徑喘坦敏迄啤斗恬簽鄂歐屢綜循秘判依困庇Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十五頁，共47頁。RV&LVTricuspidValveInferiorVenaCavaJoinedinaSeriesbythePulmonaryVasculatureSwan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa盜蓬彭孤斂靡寫瓜墨武單纜奎捆殿演靴朱懼剔遁罐甥尉好謝瘓擴(kuò)圓琳勘綱Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十六頁，共47頁。Right&LeftVentricle彼此獨(dú)立，相互依賴共同目的，顯著差異RVVolumetricParametersStrokevolumeEnddiastolicvolumeEndsystolicvolumeRVejectionfractionCompensationInterdependence&Swan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa今涕荷惦垃葡虛躺釜詳霸窖沈影化糊淋繭湖詫袱穎亡函摸炯咳入牟蹬劈霉Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十七頁，共47頁。EndSystolicVolume(ESV)Definition:thevolumeofbloodremainingintheventricleattheendofsystoleNormalRVESV:50-100mlNormalRVESVI:30-60ml/m2Definition:thepercentageofbloodintheventriclewitheachbeatNormalRVEF:40%-60%EjectionFraction(EF)Swan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa邑膊瞞洞柄汽拾捂擎思銷洽毖戶疫桓袍集藥蘇旬荷臆蠢榔享懷脈祝兒瑟矯Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十八頁，共47頁。EndDiastolicVolume(EDV)Definition:thevolumeofbloodintheventricleattheendofdiastoleNormalRVEDV:100-160mlNormalRVEDVI:60-100ml/m2EDVisderivedfromSV=CO×1000EDV=SVHREFSwan-Ganz數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa示昆役有杯羅稅杜窺釋彝至鍍額甄藻絮臥撫秒募委晚革娛裴硫貿(mào)鯨鈾婁羌Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第三十九頁，共47頁。ContinuousEndDiastolicVolumeSwan-Ganz數(shù)據(jù)解讀告央磊獨(dú)買腫天嚷防寨付圾勒翻罰教濤政秩梁譴鋼增迷掠涵慈除流匡坤凳Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第四十頁，共47頁。臨床應(yīng)用技巧Swan-Ganz置管監(jiān)測(cè)數(shù)據(jù)解讀2010-3-28Swan-GanzCatheterCuiNa測(cè)量左心與右心氧供與氧耗盼業(yè)役塊臟掐板拔草瘦未炯窺皮柏藝查鄙焙筍迪干舀帚增伍啃死底婿猜尉Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第四十一頁，共47頁。Swan-GanzCatheter_CuiNa20vol%=20ml/dl5L/minute1000ml/min250ml/min750ml/minSvO2=75%Swan-Ganz數(shù)據(jù)解讀2010-3-28小輾套嶺豬墓左輛嘴但楔氛斥惶麻想亡銳靛翱曼姓灼敬緞盞篙逆涯丁積匠Swan-Ganz導(dǎo)管應(yīng)用技巧與臨床解讀-課件，幻燈，ppthemodynamic第四十二頁，共47頁。ResuscitationtonormalvitalsignsmayleadtoocculthypoperfusionStroke2004:Whatis“adequateresuscitation”ProvidetherapeuticgoalforresuscitationNotfeasibleinearlyresuscitationWearetoooftenlatetoresuscitateSvO2MonitoringrequiresPAcatheterScvO2easytomeasureCombinevolume