外科重癥監(jiān)測(cè)治療

Intensivecare

外科重癥監(jiān)測(cè)治療

5/8/20241外科重癥監(jiān)測(cè)治療WhatisICU?Anintensivecareunit(ICU)isaspeciallystaffedandequippedhospitalwarddedicatedtothemanagementofpatientswithlife-threateningillnesses,injuriesorcomplications.重癥監(jiān)護(hù)病房(intensivecareunit,ICU)是將疑難危重患者集中監(jiān)測(cè)治療的單位。5/8/20242外科重癥監(jiān)測(cè)治療HistoryofICUICUdevelopedfromthepoliomyelitis脊髓灰質(zhì)炎epidemicintheearly1950s,whentheuseoflong-termartificialventilationresultedinreducedmortality.Mortalityofpolioepidemic87%Droppedto27%bytheuseofanesthesiamachinesforventilationofpts1952年夏，丹麥哥本哈根脊灰流行，造成延髓性呼吸麻痹，多死于呼吸衰竭。病人被集中，通過(guò)氣管切開(kāi)保持呼吸道暢通并進(jìn)行肺部人工通氣，使死亡率顯著下降。治療效果的改善，使有關(guān)醫(yī)生認(rèn)識(shí)到加強(qiáng)監(jiān)護(hù)和治療的重要性。5/8/20243外科重癥監(jiān)測(cè)治療5/8/20244外科重癥監(jiān)測(cè)治療5/8/20245外科重癥監(jiān)測(cè)治療TypeofICUpatientsTerminalillnessorirreversibleTerminalcancerPermanentbraindamageInfectiousdisease?SARS√--managementofmechanicallyventilatedsevereacuterespiratorysyndrome(SARS)patientsintheisolationintensivecareunit(ICU)--successful×5/8/20246外科重癥監(jiān)測(cè)治療costICUisgenerallythemostexpensive,technologicallyadvancedandresourceintensiveareaofmedicalcare.IntheUnitedStatesestimatesofthe2000expenditureforcriticalcaremedicinerangedfromUS$15-55billionaccountingforabout0.5%ofGDPandabout13%ofnationalhealthcareexpenditure(Halpern,2004).5/8/20247外科重癥監(jiān)測(cè)治療GerneralICUward

5/8/20248外科重癥監(jiān)測(cè)治療ICUequipment監(jiān)測(cè)設(shè)備monitoringequipment

:多功能生命體征監(jiān)測(cè)儀、呼吸功能監(jiān)測(cè)儀、心臟血流動(dòng)力學(xué)監(jiān)測(cè)儀、脈搏血氧飽和度儀、血?dú)夥治鰞x、心電圖機(jī)。監(jiān)護(hù)儀器按系統(tǒng)或器官功能參數(shù)分門(mén)排列，左列顯示功能參數(shù)，右列為治療參數(shù)。治療設(shè)備:呼吸機(jī)、除顫器、輸液泵、注射泵、起搏器、主動(dòng)脈內(nèi)球囊反搏器、血液凈化儀、麻醉機(jī)、中心供氧、中心吸引裝置、體外膜式肺氧合(ECMO)裝。5/8/20249外科重癥監(jiān)測(cè)治療監(jiān)護(hù)儀心功能監(jiān)測(cè)系統(tǒng)5/8/202410外科重癥監(jiān)測(cè)治療心電圖機(jī)5/8/202411外科重癥監(jiān)測(cè)治療便攜式血?dú)怆娊赓|(zhì)腎功檢驗(yàn)儀5/8/202412外科重癥監(jiān)測(cè)治療鐵肺—重癥監(jiān)護(hù)病房的最早嘗試5/8/202413外科重癥監(jiān)測(cè)治療呼吸機(jī)5/8/202414外科重癥監(jiān)測(cè)治療Defibrillator除顫器5/8/202415外科重癥監(jiān)測(cè)治療制氧機(jī)PulseOxymetry血氧飽和儀5/8/202416外科重癥監(jiān)測(cè)治療ICU收治對(duì)象-外科重危病人創(chuàng)傷、大手術(shù)器官移植后監(jiān)測(cè)循環(huán)失代償者有呼吸衰竭可能，需呼吸器治療者嚴(yán)重水電解質(zhì)紊亂，酸堿平衡失調(diào)者麻醉意外、心肺復(fù)蘇后病人單個(gè)或多個(gè)器官功能不全者嚴(yán)重代謝障礙性疾病(甲亢、腎上腺、垂體危象)5/8/202417外科重癥監(jiān)測(cè)治療WhatdowedoinICU?monitoringECGheartrate,rhythm,ischemiaBloodpressure

non-invasiveinvasivearterial,centralvenous,pulmonaryarteryHemodynamicmeasurement

cardiacoutputPulseoxymetryandcapnographyIntracranial,intraabdominalpressureManyotherselectrolyte,CNS5/8/202418外科重癥監(jiān)測(cè)治療WhatdowedoinICU?--TreatmentHemodynamicsupport-inotropeandvasoactivemedicationMechanicalventilationOrgansupport(eg.dialysis)SedationandanalgesiaTreatmentofunderlyingillnessesEnteral/parenteralnutrition5/8/202419外科重癥監(jiān)測(cè)治療Whyarescoringsystemsneeded?Scoringsystemscanprovide:-DefiningpopulationofcriticallyillptsAtoolforcomparativeauditAmechanismtodecideresourceallocationAnaidfortheclinicalmanagementofpatients5/8/202420外科重癥監(jiān)測(cè)治療“It’smoreimportanttoknowwhatsortofpersonthisdiseasehas,thanwhatsortofdiseasethispersonhas.”

WilliamOsler1849-19195/8/202421外科重癥監(jiān)測(cè)治療History1953–VirginiaApgar1974–GlasgowComaScaleAPACHE&SAPS–physiologicallybasedclassificationsystemsGeneralseverityscoresAimatstratifyingpatientsbasedontheirseverity1985–1993:generaloutcomepredictionmodels1991–APACHEIII1993–SAPSII2005–SAPSIII2006–APACHEIVDuringprocessofevolutionofmodels,mainprognosticdeterminantsofoutcomechanged5/8/202422外科重癥監(jiān)測(cè)治療ScoringSystemThemostcommonlyutilizedscoringsystemsaretheAPACHE(acutephysiologyandchronichealthevaluation)system,theMPM(mortalityprobabilitymodel),theSAPS(simplifiedacutephysiologyscore)system.Thesewerealldesignedtopredictoutcomesincriticalillnessanduseseverity-of-illnessscoringsystemswithcommonvariables.Theseincludeage;vitalsigns;assessmentsofrespiratory,renal,andneurologicfunction;andanevaluationofchronicmedicalillnesses

5/8/202423外科重癥監(jiān)測(cè)治療APACHEWilliamKnausInitially34physiologicalvariables1985–APACHEII12variablesAPACHEIIallowsprobabilityofdeathbeforehospitaldischargetobeestimatedStandardisedmortalityratio5/8/202424外科重癥監(jiān)測(cè)治療AssessmentofSeverityofIllness--HistoryAPACHE&SAPS–physiologicallybasedclassificationsystemsGeneralseverityscoresAimatstratifyingpatientsbasedontheirseverity1985–1993:generaloutcomepredictionmodels1991–APACHEIII1993–SAPSII2005–SAPSIII2006–APACHEIVDuringprocessofevolutionofmodels,mainprognosticdeterminantsofoutcomechanged5/8/202425外科重癥監(jiān)測(cè)治療APACHE--acutephysiologyandchronichealthevaluationWilliamKnaus1985–APACHEII12variablesTheAPACHEIIsystemisthemostcommonlyusedseverity-of-illnessscoringsysteminNorthAmerica.Age,typeofICUadmission(afterelectivesurgeryvs.nonsurgicalorafteremergencysurgery),achronichealthproblemscore,and12physiologicvariables(themostseverelyabnormalofeachinthefirst24hofICUadmission)areusedtoderiveascore.APACHEIIallowsprobabilityofdeathbeforehospitaldischargetobeestimatedStandardisedmortalityratio5/8/202426外科重癥監(jiān)測(cè)治療APACHEacutephysiologyandchronichealthevaluationAPACHEⅡ0～71

.Morerecently,theAPACHEIIIscoringsystemhasbeenreleased.ThisscoringsystemissimilartoAPACHEII,inthatitisbaseduponage,physiologicabnormalities,andchronicmedicalcomorbidities.Thedatabasefromwhichthisscorewasderivedislarger

APACHEⅢ0～299,Tab14-1intextbook5/8/202427外科重癥監(jiān)測(cè)治療APACHEIIscore=(acutephysiologyscore)+(agepoints)+(chronichealthpoints)Scoresrangefrom0–71Scoreriskofhospitaldeath5/8/202428外科重癥監(jiān)測(cè)治療5/8/202429外科重癥監(jiān)測(cè)治療5/8/202430外科重癥監(jiān)測(cè)治療SAPS—SimplifiedAcutePhysiologyScore17variablesTheSAPSIIscore,usedmorefrequentlyinEurope,wasderivedinamannersimilartotheAPACHEscores.

LeGallreducedformer34-variableAPACHEscoreto14parametersThisscoreisnotdiseasespecificbutratherincorporatesthreeunderlyingdiseasevariables(AIDS,metastaticcancer,andhematologicmalignancy).

專(zhuān)科評(píng)分神經(jīng)系統(tǒng)Glasgowcomascore(GCS)*心臟功能Goldman肝硬化Child-Turcotte

燒傷指數(shù)5/8/202431外科重癥監(jiān)測(cè)治療5/8/202432外科重癥監(jiān)測(cè)治療5/8/202433外科重癥監(jiān)測(cè)治療MPM—MortlityprobabilitymodelMPM-Ⅰ1985MPM-Ⅱ1993MPM0，MPM24，MPM48

TheMPMcanbeusedtocalculateadirectprobabilityofdeathinpatientsadmittedtotheICUSeverity-of-illnessscoringsystemssufferfromtheproblemofinabilitytopredictsurvivalinindividualpatients.Thesetoolsshouldbeusedasimportantdatatocomplementclinicalbedsidedecision-making.5/8/202434外科重癥監(jiān)測(cè)治療MPM(MortalityPredictionModels)DevelopedbyStanleyLemeshowUsesdatacollectedduringfirsthourofICUadmission;24hours;72hoursSeriesoftrue/falsequestionsWeightedaccordingtotheirindividualcontributiontomortality5/8/202435外科重癥監(jiān)測(cè)治療MonitoringofRespiratoryfunction床旁觀察既簡(jiǎn)單又實(shí)用。general:ConsciousnessRespiratorymovements，Respiratoryrate、apnea呼吸音。mucous5/8/202436外科重癥監(jiān)測(cè)治療呼吸運(yùn)動(dòng)的觀察呼吸頻率(RR)AdultRR10-18beat/min每分鐘肺泡通氣量(minuteventilation,MV

MV)=[tidalvolume(VT)－deadvolume(VD)]×RR5/8/202437外科重癥監(jiān)測(cè)治療呼吸功能測(cè)定肺容量監(jiān)測(cè)—反映靜態(tài)通氣功能潮氣量(tidalvolume,VT)補(bǔ)吸氣量(inspiratoryreservevolume,IRV)深吸氣量(inspiratorycapacity,IC)補(bǔ)呼氣量(expiratoryreservevolume,ERV)殘氣量(residualvolume,RV)功能殘氣量(functionalresidualcapacity,FRC)肺活量(vitalcapacity,VC)肺總量(totallungcapacity,TLC)Normal--->80%predictedvalue5/8/202438外科重癥監(jiān)測(cè)治療Oxygentherapy氧治療Oxygentherapyistheadministrationofoxygenasamedicalintervention,whichcanbeforavarietyofpurposesinbothchronicandacutepatientcare.氧治療是通過(guò)吸入不同濃度的氧，使吸入氧濃度(F1O2)和肺泡氣的氧分壓(PAO2)升高，以升高動(dòng)脈血氧分壓(PaO2)，達(dá)到緩解或糾正低氧血癥的目的。Indication:

CardiacandresparrestRespfailuretypeⅠ,typeⅡCardiacfailureorMIShockIncreasemetabolicdemandsPost-operativestatesCarbonmonoxidepoisoning5/8/202439外科重癥監(jiān)測(cè)治療Oxygentherapy氧療方法:高流量系統(tǒng)，如文圖里(Venturi)面罩(F1O2穩(wěn)定)。低流量系統(tǒng)，如鼻導(dǎo)管吸氧、面罩吸氧、帶貯氣囊面罩吸氧等(F1O2不穩(wěn)定)。氧療護(hù)理:加強(qiáng)監(jiān)測(cè)、預(yù)防交叉感染、濕化吸入氣體、注意防火和安全。5/8/202440外科重癥監(jiān)測(cè)治療MechanicalVentilation機(jī)械通氣:人工氣道Inmedicine,mechanicalventilationisamethodtomechanicallyassistorreplacespontaneousbreathing

Artificialairway:endotrachealintubationortracheostomy氣管插管或氣管切開(kāi)。5/8/202441外科重癥監(jiān)測(cè)治療IndicationofmechanicalventilationAcutelunginjury(includingARDS,trauma)ApneawithrespiratoryarrestChronicobstructivepulmonarydisease(COPD)Acuterespiratoryacidosiswithpartialpressureofcarbondioxide(pCO2)>50mmHgandpH<7.25,whichmaybeduetoparalysisofthediaphragmduetoGuillain-Barrésyndrome,MyastheniaGravis,spinalcordinjury,ortheeffectofanaestheticandmusclerelaxantdrugsIncreasedworkofbreathingasevidencedbysignificanttachypnea,retractions,andotherphysicalsignsofrespiratorydistressHypoxemiawitharterialpartialpressureofoxygen(PaO2)withsupplementalfractionofinspiredoxygen(FiO2)<55

mmHgHypotensionincludingsepsis,shock,congestiveheartfailure

Neurologicaldiseases5/8/202442外科重癥監(jiān)測(cè)治療TypesofventilatorsVentilationcanbedeliveredvia:Hand-controlledventilationsuchas:

Bagvalvemask

Continuous-floworAnaesthesia(orT-piece)bag

Amechanicalventilator.Typesofmechanicalventilatorsinclude:Transportventilators.Theseventilatorsaresmall,morerugged,andcanbepoweredpneumaticallyorviaACorDCpowersources.ICUventilators..NICUventilators.Designedwiththepretermneonateinmind,.PAPventilators.theseventilatorsarespecificallydesignedfornon-invasiveventilation.thisincludesventilatorsforuseathome,inordertotreatsleepapnea5/8/202443外科重癥監(jiān)測(cè)治療MechanicalVentilation:modesControlmodeventilation(CMV):控制通氣Asist/controlmodeventilation(A/CMV):輔助/控制通氣Intermittentmandatoryventilation(IMV):間歇指令通氣SynchronizedIntermittentmandatoryventilation(SIMV):同步間歇指令通氣Pressuresupportventilation(PSV):壓力支持通氣Positiveendrespiratorypressure(PEEP):呼氣末正壓通氣WeaningfromMechanicalVentilat呼吸機(jī)的撤離:臨床綜合判斷、撤機(jī)生理參數(shù)、撤機(jī)觀察呼吸頻率、節(jié)律、深度、呼吸方式；監(jiān)測(cè)心率、血壓、有無(wú)出汗、紫紺、呼吸窘迫。5/8/202444外科重癥監(jiān)測(cè)治療arterialblood-gasanalysis(ABG)Evaluationofrespiratorygasexchangeisroutineincriticalillness.The"goldstandard"remainsarterialblood-gasanalysis,wherepH,partialpressuresofO2andCO2,andO2saturationaremeasureddirectly.Witharterialblood-gasanalysis,thetwomainfunctionsofthelung—oxygenationofarterialbloodandeliminationofCO2—canbedirectlyassessed.Importantly,thebloodpH,whichhasaprofoundeffectonthedrivetobreathe,canbeassessedonlybysamplingofarterialblood.Thoughsamplingofarterialbloodisgenerallysafe,itmaybepainfulandcannotprovidecontinuousinformationforcliniciansroutinely.Giventheselimitations,noninvasivemonitoringofrespiratoryfunctionisoftenemployedinthecriticalcaresetting.5/8/202445外科重癥監(jiān)測(cè)治療Arterialblood-gasanalysispH:7.35～7.45PaO2

:12～13.3kPa(90~100mmHg)PaCO2:4.7～6kPa(35~45mmHg)SaO2(SAT):正常值96~100%CaO2(動(dòng)脈血O2含量):正常值16~20ml/dl實(shí)際HCO-3(AB)和標(biāo)準(zhǔn)HCO-3(SB):22～27mmol/L(24)AB>SB:呼酸AB<SB:呼堿:AB=SB正常。兩者均增加:失代償性代堿；兩者均降低:失代償性代酸堿剩余(BE):-3～+3mmol/L緩沖液(BB):包括HCO-3和P-r。正常值45～55mmol/L。血漿陰離子間隙(AGp):正常值7-16mmol/LTCO2(CO2總量)正常值28-353mmol/L5/8/202446外科重癥監(jiān)測(cè)治療PulseOximetry

脈搏血氧飽和度(SpO2)PulseOximetryisthemostcommonlyutilizednoninvasivemonitorofrespiratoryfunction.Thistechniquetakesadvantageofdifferencesintheabsorptivepropertiesofoxygenatedanddeoxygenatedhemoglobin.脈搏血氧飽和度是通過(guò)脈搏血氧監(jiān)測(cè)儀(pulseoximeter，POM)利用紅外線測(cè)定末梢組織中氧合血紅蛋白含量，間接測(cè)得SpO2。正常值95～100%。

SpO2監(jiān)測(cè)的影響因素正鐵血紅蛋白(MetHb)與碳氧血紅蛋白(COHb)愈高其SpO2測(cè)值愈低。體溫因素:低體溫致SpO2降低。低血壓肢端末梢循環(huán)不良:當(dāng)<50mmHg，SpO2下降。測(cè)定部位:測(cè)定部位其皮膚組織愈厚，精確度愈低。皮膚色素:色素沉著、指甲染料SpO2偏低。血管收縮劑:使SpO2測(cè)值下降。5/8/202447外科重癥監(jiān)測(cè)治療expiratoryC02monitoring，PETC02呼氣末C02監(jiān)測(cè)PETC02end-tidalCO2

呼氣末C02監(jiān)測(cè)主要根據(jù)紅外線原理、質(zhì)譜原理、拉曼散射原理和圖—聲分光原理而設(shè)計(jì)，主要測(cè)定呼氣末二氧化碳。noninvasive呼氣末二氧化碳濃度(EtC02)呼出氣二氧化碳濃度在呼氣末最高，接近肺泡氣水平(約3.5％～5％)，其與PaC02的相關(guān)性良好，可據(jù)此間接估計(jì)PaC02。正常值35～45mmHg5/8/202448外科重癥監(jiān)測(cè)治療Hemodynamicmonitoring血流動(dòng)力學(xué)監(jiān)測(cè)Hemodynamicmeasurementsareimportanttoestablishaprecisediagnosis,determineapropriatetherapy.Monitormaybecategorizedinto

Non-invasive

electrocardiogram(ECG)non-invasivebloodpressure(NIBP)urineoutputechocardiographyandDopplerInvasive

ArterialbloodpressurecentralvenouspressurePulmonaryarterycatheter,Swan-Ganzcatheter漂浮導(dǎo)管

5/8/202449外科重癥監(jiān)測(cè)治療Electrocardiogram,ECG心電圖ECGdiagnoseischemia,MIarrhythmia

monitoringfunctionofpacer5/8/202450外科重癥監(jiān)測(cè)治療動(dòng)脈壓(NIBP,ABP)Non-invasivebloodpressuredevicesuseanoscillotonometrictechnique.袖帶測(cè)壓、自動(dòng)無(wú)創(chuàng)測(cè)壓(NIBP)Theycangiveerroneousresultinptswitharrhythmia(Af)。Invasive:

Arterialbloodpressureuseanarterialcatheterandtranducertechnique動(dòng)脈穿刺插管直接測(cè)壓meanarterialpresssure,MAP平均動(dòng)脈壓是指心動(dòng)周期的平均血壓。能評(píng)估左室泵功能、器官和組織血流。正常值8~13.3kPa。MAP=DBp＋1/3(SBp－DBp)＝CO×SVR。5/8/202451外科重癥監(jiān)測(cè)治療centralvenouspressure,CVP

中心靜脈壓CVPcanbemonitoredusingcathetersinsertedviatheinternaljugular,subclavianandfemoralveins.CVP胸腔內(nèi)上、下腔靜脈或右心房?jī)?nèi)的壓力。是評(píng)估血容量、右心前負(fù)荷及右心功能的重要指標(biāo)。正常值為5-12cmH2O。CVP過(guò)低為血容量不足或靜脈回流受阻；CVP過(guò)高為輸入液體過(guò)多或心功能不全。適應(yīng)癥:各類(lèi)大中手術(shù)，尤心胸顱腦手術(shù)；各種休克；脫水、失血和血容量不足；心力衰竭；大量靜脈輸血、輸液或靜脈高能量營(yíng)養(yǎng)。5/8/202452外科重癥監(jiān)測(cè)治療5/8/202453外科重癥監(jiān)測(cè)治療CVP注意事項(xiàng)注意事項(xiàng):判斷導(dǎo)管插入上、上腔靜脈或右房無(wú)誤。玻璃管零點(diǎn)對(duì)第4肋間右心房水平。確保管道內(nèi)無(wú)凝血、空氣，管道無(wú)扭曲。測(cè)壓時(shí)確保靜脈內(nèi)導(dǎo)管通暢無(wú)阻。加強(qiáng)管理，嚴(yán)格無(wú)菌操作。并發(fā)癥:感染、出血和血腫、其它血?dú)庑?、血?dú)馑ǖ取?/8/202454外科重癥監(jiān)測(cè)治療Swan-Ganzcatheter漂浮導(dǎo)管Swan-Ganz導(dǎo)管用聚氯乙烯材料推壓而成，不透X線。成人有5F、6F、7F、7.5F，全長(zhǎng)110cm，每10cm有黑色環(huán)形標(biāo)記。兒童有4F和5F，全長(zhǎng)60cm。四腔Swan-Ganz導(dǎo)管:端孔為主腔開(kāi)口用于監(jiān)測(cè)肺動(dòng)脈壓和采集血標(biāo)本。距管端30cm處有一側(cè)孔,用于監(jiān)測(cè)右房壓、CVP、CO和輸液。熱敏計(jì)位于距管端4cm處，用于感知熱阻抗的變化，尾端與計(jì)算機(jī)相連。端孔1-2mm處有一氣囊與尾端的注射器相連可注入氣體(1.25-1.5ml)。5/8/202455外科重癥監(jiān)測(cè)治療Swan-Ganz原理心室舒張末期，主動(dòng)脈瓣和肺動(dòng)脈瓣均關(guān)閉，而二尖瓣開(kāi)放形成液流內(nèi)腔。心室舒張末壓(LVDEP)=肺動(dòng)脈舒張壓(PADP)=肺小動(dòng)脈楔壓(PAWP)=肺毛細(xì)血管楔壓(PCWP)。PCWP:pulmonaryarterycapillarywedgepressure臨床意義估價(jià)左右心室功能區(qū)別心源性和非心源性肺水腫指導(dǎo)治療選擇最佳PEEP確定漂浮導(dǎo)管位置5/8/202456外科重癥監(jiān)測(cè)治療肺動(dòng)脈楔壓(pulmonaryaorticwedgepressure,PAWP)正常值為0.8~1.6kPa?？膳卸ㄗ笮氖夜δ?，反映血容量是否充足。＞2.4kPa:左心功能不全、急性心源性肺水腫；＜2.4kPa:急性肺損傷、ARDS。肺毛細(xì)血管楔壓(PCWP)正常值0.67~1.87kPa。反映左心房平均壓及左心室舒張末期壓。＜0.8kPa:體循環(huán)血容量不足；＞2.4kPa:即將或已出現(xiàn)肺淤血；＞4kPa:肺水腫。平均肺動(dòng)脈壓(meanpulmonaryarterialpresssure,MPAP)正常值1.47~2.0kPa。MPAP升高見(jiàn)于肺血流量增加、肺血管阻力升高、二尖瓣狹窄、左心功不全。MPAP降低見(jiàn)于肺動(dòng)脈瓣狹窄。5/8/202457外科重癥監(jiān)測(cè)治療Swan－Ganz導(dǎo)管適應(yīng)證ARDS左心衰循環(huán)功能不穩(wěn)定急性心肌梗塞區(qū)分心源性和非心源性肺水腫心血管手術(shù)肺栓塞嚴(yán)重創(chuàng)傷，各類(lèi)休克，嗜鉻細(xì)胞瘤等。5/8/202458外科重癥監(jiān)測(cè)治療床邊盲目置管就是通過(guò)導(dǎo)管在某一心臟內(nèi)的壓力波形來(lái)間接判斷其位置所在，需同步心電圖監(jiān)測(cè)。波形變化依次為右房，右室，肺動(dòng)脈和肺毛壓。漂浮導(dǎo)管測(cè)得右房、右室、肺動(dòng)脈及肺毛細(xì)血管楔壓5/8/202459外科重癥監(jiān)測(cè)治療Swan-Ganz導(dǎo)管并發(fā)癥心律失常氣囊破裂肺梗塞肺動(dòng)脈破裂和出血導(dǎo)管打結(jié)血栓形成心包填塞感染5/8/202460外科重癥監(jiān)測(cè)治療心輸出量(cardiacoutput,CO)正常值4~8L/min。指每分鐘心臟的射血量，反映左心功能。CO降低見(jiàn)于回心血量減少、心臟流出道阻力增加、心肌收縮力減弱。經(jīng)Swan-Ganz導(dǎo)管熱稀釋法測(cè)定心排血量，脈動(dòng)脈與右心房的血液溫度差值與時(shí)間、流量有關(guān)，據(jù)此即可計(jì)算出心排出量。心功能曲線5/8/202461外科重癥監(jiān)測(cè)治療Hemodynamicmonitoring每搏排出量(strokevolume,SV)指一次心搏由一側(cè)心室射出的血量。成年人安靜、平臥時(shí)為60~90m