重癥監(jiān)護(hù)產(chǎn)品知識(shí)概要指南

重癥監(jiān)護(hù)產(chǎn)品知識(shí)概要指南GuidelinesofCriticalCareProductKnowledgeRequirementPart1AnatomyandPhysiology第一部分解剖和生理Objectivesepurposeofthevascularsystem描述血管系統(tǒng)的用途2．Identifythemainstructuresofthethoraciccavity識(shí)別胸腔的主要結(jié)構(gòu)3．Identifythefollowingarteriesandveinsinthethoraciccavity:識(shí)別在胸腔中的以下動(dòng)脈和靜脈ArteryVein動(dòng)脈靜脈-aorticarch主動(dòng)脈弓-inferiorvenacava上腔靜脈-ascendingaorta升主動(dòng)脈-superiorvenacava下腔靜脈-descendingthoracicaorta降主動(dòng)脈-brachiocephalic(innominate)頭臂動(dòng)脈(無(wú)名動(dòng)脈)-leftmaincoronary左主冠脈-leftsubclavian左鎖骨下動(dòng)脈-pulmonary肺動(dòng)脈-rightcoronary右冠脈-rightsubclavian右鎖骨下動(dòng)脈4．Identifythefollowingarteriesandveinsinthevascularsystem:識(shí)別以下的血管系統(tǒng)的動(dòng)脈和靜脈Artery動(dòng)脈-brachial臂動(dòng)脈-femoral股動(dòng)脈-iliac髂動(dòng)脈靜脈-popliteal腘動(dòng)脈-renalarteries腎動(dòng)脈-abdominalaorta腹主動(dòng)脈-descendingthoracicaorta降主動(dòng)脈-externalcarotid頸外動(dòng)脈脈Vein靜脈-brachial臂靜脈-femoral股靜脈-iliac髂-popliteal腘靜脈-renalveins腎靜脈-axillary腋靜脈-cephalic頭靜脈-externaljugular頸外靜-internalcarotid頸內(nèi)動(dòng)脈-internaljugular頸內(nèi)靜脈-leftcommoncarotid左頸總動(dòng)脈-saphenous大隱靜脈-radial橈動(dòng)脈-subclavian鎖骨下靜脈-posteriortibial脛后動(dòng)脈-ulnarartery尺動(dòng)脈-vertebral椎動(dòng)脈-dorsalispedis足背動(dòng)脈Objectives描述心臟的用途ngstructuresin-rightatrium右心房-rightventricle右心室-apexoftheheart心尖gstructureson臟橫截面結(jié)構(gòu)：-rightatrium右心房-leftatrium左心房-rightventricle右心室-leftventricle左心室-pulmonaryvalve肺動(dòng)脈瓣-aorticvalve主動(dòng)脈瓣natomicalfunctionsof識(shí)別以下結(jié)構(gòu)的解剖功能thethoraciccavity:-leftatrium左心房-leftventricle左心室-pericardium心包across-sectionoftheheart:-mitralvalve二尖瓣-tricuspidvalve三尖瓣-chordaetendineae腱索-papillarymuscles乳突肌-interventricularseptum室間膈thefollowingstructures:-rightatrium右心房-leftatrium左心房-rightventricle右心室-leftventricle左心室-pulmonaryvalve肺動(dòng)脈瓣-aorticvalve主動(dòng)脈瓣-mitralvalve二尖瓣-tricuspidvalve三尖瓣-chordaetendineae腱索-papillarymuscles乳突肌Objectives1．ExplainhowthecardiaccyclerelatestotheECGandhemodynamicwaveform解釋心動(dòng)周期和心電圖以及血流動(dòng)力學(xué)波形是如何相關(guān)的2．Identifythephasesofthecardiaccycle識(shí)別心動(dòng)周期的各個(gè)階段3．Describewhatishappeningduringeachphaseofthecardiaccycle2．Equipmentset-up描述在每個(gè)心動(dòng)周期階段中發(fā)生什么Objectives:efine-preload前負(fù)荷-afterload后負(fù)荷-contractility心肌收縮力-cardiacoutput心排量-cardiacindex心排指數(shù)-strokevolume每搏量-strokevolumeindex每搏指數(shù)-systemicvascularresistance體循環(huán)阻力-pulmonaryvascularresistance肺循環(huán)阻力-leftventricularstrokeworkindex左心室每搏功指數(shù)-rightventricularstrokeworkindex右心室每搏指數(shù)-myocardialoxygensupply心肌氧供應(yīng)-myocardialoxygendemand心肌氧需求2．Identifythefactorsthataffect識(shí)別影響以下內(nèi)容的因素-preload前負(fù)荷-afterload后負(fù)荷-contractility心肌收縮力-myocardialoxygensupply心肌氧供應(yīng)-myocardialoxygendemand心肌氧需求Part2PRESSUREMONITORING第二部分壓力監(jiān)測(cè)1．ComponentsofPressureMonitoringSystems壓力監(jiān)測(cè)系統(tǒng)的組成ElectricalSystem電子系統(tǒng)Plumbing/FluidSystem沖刷/液體系統(tǒng)Continuousflushdevice連續(xù)沖刷裝置Pressuretransducer壓力傳感器Pressurebag壓力包IVsolution(withorwithoutheparin)靜脈輸注液體(含或不含肝素)系統(tǒng)設(shè)置Setpressurescaleinmonitoringsystem在監(jiān)護(hù)系統(tǒng)上設(shè)置壓力刻度Assemblesystemandflushsystemwithsolution裝配系統(tǒng)并用液體沖刷系統(tǒng)Setpressurebagto300mmHg將壓力包加壓到300mmHgZeroingandreferencingthecatheter-tubing-transducersystem調(diào)零并定位導(dǎo)管－管路－傳感器系統(tǒng)3．Interferencewithinthesystem系統(tǒng)內(nèi)部的干擾Dynamicresponse動(dòng)力學(xué)反應(yīng)Frequencyresponse固有頻率Damping衰減Squarewaveformresponse方波測(cè)試4．MaintenanceofSystem系統(tǒng)維護(hù)Issueswithfrequencyofzeroing調(diào)零的頻率問(wèn)題Maintainpressure(300mmHg)withinpressurebag維持壓力包內(nèi)的壓力Drawingbloodsamples抽取血液樣品5．WheretotakeReadingsofPressureMeasurements在何處讀取壓力監(jiān)測(cè)的讀數(shù)Effectsofrespiration(inhalation/exhalation)呼吸的影響(吸氣/呼氣)Readingsbesttakenatend-expiration最好在呼氣末期讀取讀數(shù)－SpontaneousBreathing自發(fā)呼吸－MechanicalVentilation機(jī)械通氣6．ProblemsthatMayBeEncountered–TroubleshootingDampedwaveform衰減波形Abnormallylowornegativepressures不正常的低壓或者負(fù)壓Inabilitytowedge無(wú)法契入Falsehighpressurereadings錯(cuò)誤的高壓力讀數(shù)OverwedgingofPAWpressuretracing過(guò)度契入的肺動(dòng)脈契壓波形Catheterwhip導(dǎo)管漂移Inabilitytoflush/drawblood無(wú)法沖刷/抽血7．ArterialPressureMonitoring動(dòng)脈壓力監(jiān)測(cè)Purpose目的Sites位點(diǎn)Waveform波形Complications并發(fā)癥8．Bloodperforms2mainfunctionswhilecirculatingtheBody血液在體內(nèi)循環(huán)時(shí)的2個(gè)主要功能9．Factorsthatcontrolbloodpressure控制血壓的因素Increased/decreasedheartrate心率增加/降低Heartpumpingtoomuch/toolittleblood心臟泵血過(guò)多/過(guò)少Someorgansarebypassed,shockoraftermeals某些器官分流，比如，休克或者進(jìn)餐后Thickeningofarteries動(dòng)脈增厚Constrictionofarteries動(dòng)脈收縮10.TypicalPressuresandValues典型的壓力和數(shù)值RightHeartEmptyingpressure右心排空壓力LeftHeartFillingPressurePulmonaryArteryPressurePAOP/PAWPRightHeartFillingPressureLeftHeartEmptyingPressureCentralVenousPressureArterialPressure左心充盈壓肺動(dòng)脈壓肺動(dòng)脈阻斷壓/契壓右心充盈壓左心排空壓力動(dòng)脈壓11.Whymeasurepressures為什么測(cè)定壓力12．Whichproductsaretraditionallyusedtoaccessthesepressuremeasurements在測(cè)定上述壓力時(shí)應(yīng)用的傳統(tǒng)產(chǎn)品是什么Part4HemodynamicMonitoring第四部分血流動(dòng)力學(xué)監(jiān)測(cè)1．Thegoalofthehemodynamicmonitoring血流動(dòng)力學(xué)監(jiān)測(cè)的目標(biāo)2．Thepurposeofhemodynamicmonitoring血流動(dòng)力學(xué)監(jiān)測(cè)的目的PreventionDiagnosisManagement防診斷3．CardiacOutput心排量Definition定義Formula公式NormalCardiacOutput正常心排量4．CardiacIndex心排指數(shù)Definition定義Normal正常值Impactofheartrate心率的影響B(tài)radyarrhythmiasTachyarrhythmiasStrokeVolume每搏量Definition定義Determinants決定因素Preload前負(fù)荷Afterload后負(fù)荷Contractility收縮力5．ControversiessurroundingtheuseofthePulmonaryArteryCatheter(PAC)圍繞肺動(dòng)脈導(dǎo)管應(yīng)用的爭(zhēng)議1996–the“Connors”studyPractitionerknowledgeregardingtheuseofhemodynamicparameters執(zhí)業(yè)醫(yī)師對(duì)于血流動(dòng)力學(xué)參數(shù)應(yīng)用的知識(shí)1996SCCMPACConscensusMeeting1996年重癥監(jiān)護(hù)醫(yī)學(xué)會(huì)肺動(dòng)脈導(dǎo)管研討會(huì)PACEP肺動(dòng)脈導(dǎo)管教育項(xiàng)目Outcomestudies結(jié)果研究chnology追擊“無(wú)創(chuàng)”技術(shù)Bioimpedencecardiacoutputmeasurements生物阻抗心排量測(cè)定Transesophagealechocardiograms/probes經(jīng)食道超聲/探頭LITCO鋰指示劑稀釋法心排量測(cè)定Pulsion動(dòng)脈壓力波形和脈搏輪廓分析心排量測(cè)定6.ThePulmonaryArteryCatheter肺動(dòng)脈導(dǎo)管CatheterPorts導(dǎo)管端口Proximalport近端端口VIPportVIP端口DistalportBalloonportThermistorSideportonIntroducerSheath7.IndicationsforPulmonaryArteryPressureMonitoring肺動(dòng)脈壓力監(jiān)測(cè)的適應(yīng)癥8.Direct&DerivedParametersAssociatedwithHemodynamicMonitoring和血流動(dòng)力學(xué)監(jiān)測(cè)相關(guān)的直接和衍生參數(shù)Direct直接DerivedParameters衍生參數(shù)9.InsertionofPAC肺動(dòng)脈導(dǎo)管插入Insertionsites插入位點(diǎn)Insertionmethods插入方法Observeforwaveformchangesduringtheinsertion在插入過(guò)程中觀察波形的變化RightAtrialPressure右心房壓力PurposeforUse應(yīng)用的目的Normals正常NormalsNeonateChildAdult新生兒人RAWaveform右心房壓力波形RightVentriclePressure右心室壓力PurposeforUse應(yīng)用的目的Normals正常值Neonate新生兒Child兒童Adult成人RVWaveform右心室波形PulmonaryArteryPressure肺動(dòng)脈壓PurposeforUse應(yīng)用的目的PAsystolicpressure肺動(dòng)脈收縮壓PAdiastolicpressure肺動(dòng)脈舒張壓PAmeanpressure(PAM)肺動(dòng)脈平均壓PulmonaryArteryWedgePressure(Pawp/Paop)Assumptions假設(shè)Inflationvolume球囊充盈容量Normals正常值WaveformNeonateChildAdult波形新生兒人CatheterMaintenance導(dǎo)管維護(hù)ProblemswithPAcatheters/lines肺動(dòng)脈導(dǎo)管/線(xiàn)路使用的問(wèn)題10．DERIVEDPARAMETERS衍生參數(shù)MeanArterialPressure平均動(dòng)脈壓Definition定義CausesofincreasedMAP平均動(dòng)脈壓增高的原因CausesofdecreasedMAP平均動(dòng)脈壓降低的原因MeanPulmo