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肺动脉漂浮导管的临床应用 Starling定律: 心脏的每搏搏出量取决于心脏舒张期的心室内容量(preload) 在一定限度内,舒张期心室内容量越大,收缩期每搏量越大 最适宜的左心室充盈压为15mmHg(1.99kPa),此时心搏出量最高 因此,测定左心的前负荷是理想的指标: 左心室舒张未容量(LVEDV) 左心室舒张未压力(LVEDP) 但临床测定较困难 理论基础 LVEDP 4~12 mmHg Mean: 8 mmHg LAP 4~12 mmHg Mean:8mmHg PVP PCWP 5~15 mmHg Mean: 10 mmHg 1970年以前,肺动脉导管是“猪尾巴样” 从粗到细很长 正常的思维 1970年,H.J. C Swan和William Ganz发明了带套囊的肺动脉漂浮导管,即 Swan-Ganz导管 Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscope. A NO.5 Fr double-lumen catheter with a balloon just proximal to the tip is inserted into the right atrium under pressure monitoring. The balloon is then inflated with 0.8ml of air. The balloon is carried by blood flow through the right side of the heart into the smaller radicles of the pulmonary artery. In this position when the balloon is inflated wedge pressure is obtained. The average time for passage of the catheter from the right atrium to the pulmonary artery was 35seconds in the first 100 patients. The frequency of premature beats was minimal,and no other arrhythmias occurred. New England Journal of Medicine (1970) Table 6 NORMAL INTRACARDIAC PRESSURES(mmHg) Type Mean Range Right atrial pressure 5 1-10 Right ventricular end-systolic/end- 25/5 15-30/0-8 diastolic pressure Pulmonary arterial systolic/diastolic 23/9 15-30/5-15 pressure Mean pulmonary arterial pressure 15 10-20 Pulmonary capillary wedge pressure 10 5-15 Left atrial pressure 8 4-12 Left ventricular end-diastolic pressure 8 4-12 Left ventricular systolic pressure 130 90-140 Table 7 DERIVED HEMODYNAMIC PARAMETERS F
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