血流动力学监控09双语.ppt

Hemodynamic Monitoring and Modulation血流动力学的监测与调控 长江大学附属一医院麻醉科 夏 瑞 Significance of hemodynamic monitoring 所有危重病人，都伴有程度不同的血流动力学障碍； 血流动力学异常更会影响全身各系统、器官的功能； 维持血流动力学正常，是抢救各种危重病人的关键； 在临床医疗实践中，可以通过人工的方法控制血流动力学，为一些疾病的治疗创造条件。 血流动力学(Hemodynamics)监控是临床麻醉和ICU的重要内容之一； 也是一个临床医师必备的基本技能。 Main contents Overview of cardiovascular system Monitoring of circulatory function Management of hemodynamics Overview of cardiovascular system第一节 心血管系统概述 Cardiovascular System Overview Responsibilities of cardiovascular system（功能） Pumping blood to the body tissues and cells Supplying oxygen and nutrients to tissues and cells Removing carbon dioxide and other waste products of metabolism from tissues and cells Cardiovascular System Heart Center of the circulatory system Circulation through the heart Pulmonary circulation Circulation of blood from the heart to the lungs for oxygenation and back to the heart Systemic circulation Circulation of blood from the heart to all parts of the body and back to the heart Conduction system of the heart 一、Heart 心脏 Cardiac output, CO Be defined as the volume of blood pumped by the heart per minute CO＝SV × HR Cardiac Index , CI=CO/BSA EF=SV/EDV × 100% Determinants of ventricular performance Heart rate Stroke volume, SV Preload Afterload Contractility Wall motion abnormalities Valvular dysfunction 二、Circulation 外周循环 Blood flow＝ Monitoring of circulatory function第二节 循环功能监测 Monitoring of circulatory function循环功能监测 Clinical signs（临床症状） ECG（心电图） Arterial blood pressure（动脉血压） Central venous pressure（CVP 中心静脉压） Pulmonary artery cannulation（肺动脉导管） Echocardiography（心脏超声） 一、Clinical signs and symptoms of perfusion abnormalities Central nervous system: Mental status changes Cardiovascular system: Chest pain, shortness of breath, ECG abnormalities Renal 肾脏: Decreased urine output ( below 0.5~1.0ml/kg/min) Peripheral 外周: Cool limbs Poor capillary refill（﹥2s） Diminished pulses 二、Electrocardiogram (ECG) 心电图 The ECG is used to determine the HR and to