歡迎閱讀本文檔，希望本文檔能對(duì)您有所幫助!歡迎閱讀本文檔，希望本文檔能對(duì)您有所幫助!感謝閱讀本文檔，希望本文檔能對(duì)您有所幫助!感謝閱讀本文檔，希望本文檔能對(duì)您有所幫助!歡迎閱讀本文檔，希望本文檔能對(duì)您有所幫助!感謝閱讀本文檔，希望本文檔能對(duì)您有所幫助!GuidelinesofCriticalCareProductKnowledgeRequirementPart1AnatomyandPhysiology第一部分解剖和生理一．VascularAnatomy血管解剖Objectives目標(biāo)1．Describethepurposeofthevascularsystem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ArteryVein動(dòng)脈靜脈-brachial臂動(dòng)脈-brachial臂靜脈-femoral股動(dòng)脈-femoral股靜脈-iliac髂動(dòng)脈-iliac髂靜脈-popliteal腘動(dòng)脈-popliteal腘靜脈-renalarteries腎動(dòng)脈-renalveins腎靜脈-abdominalaorta腹主動(dòng)脈-axillary腋靜脈-descendingthoracicaorta降主動(dòng)脈-cephalic頭靜脈-externalcarotid頸外動(dòng)脈-externaljugular頸外靜脈-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)脈二．CardiacAnatomy心臟解剖Objectives目標(biāo)1．Describethepurposeoftheheart描述心臟的用途2．Identifythefollowingstructuresinthethoraciccavity:識(shí)別胸腔內(nèi)的以下結(jié)構(gòu)：-rightatrium右心房-leftatrium左心房-rightventricle右心室-leftventricle左心室-apexoftheheart心尖-pericardium心包3．Identifythefollowingstructuresonacross-sectionoftheheart:識(shí)別以下的心臟橫截面結(jié)構(gòu)：-rightatrium右心房-mitralvalve二尖瓣-leftatrium左心房-tricuspidvalve三尖瓣-rightventricle右心室-chordaetendineae腱索-leftventricle左心室-papillarymuscles乳突肌-pulmonaryvalve肺動(dòng)脈瓣-interventricularseptum室間膈aorticvalve主動(dòng)脈瓣4．Identifytheanatomicalfunctionsofthefollowingstructures:識(shí)別以下結(jié)構(gòu)的解剖功能-rightatrium右心房-aorticvalve主動(dòng)脈瓣-leftatrium左心房-mitralvalve二尖瓣-rightventricle右心室-tricuspidvalve三尖瓣-leftventricle左心室-chordaetendineae腱索-pulmonaryvalve肺動(dòng)脈瓣-papillarymuscles乳突肌三．CardiacCycle心動(dòng)周期Objectives目標(biāo)1．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．Describewhatishappeningduringeachphaseofthecardiaccycle描述在每個(gè)心動(dòng)周期階段中發(fā)生什么四．DeterminantsofCardiacOutput心排量決定因素Objectives:目標(biāo)1．Define定義-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)一．ClinicalFundamentals臨床基本知識(shí)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)2．Equipmentset-up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)零的頻率問題Maintainpressure(300mmHg)withinpressurebag維持壓力包內(nèi)的壓力(300mmHg)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–Troubleshooting可能遇到的問題――故障排除Dampedwaveform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 心臟泵血過多/過少 Someorgansarebypassed,i.eshockoraftermeals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LeftHeartFillingPressure左心充盈壓PulmonaryArteryPressure肺動(dòng)脈壓PAOP/PAWP肺動(dòng)脈阻斷壓/契壓RightHeartFillingPressure右心充盈壓LeftHeartEmptyingPressure左心排空壓力CentralVenousPressure中心靜脈壓ArterialPressure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Prevention預(yù)防Diagnosis診斷Management管理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”study1996年－“Connors”研究Practitionerknowledgeregardingtheuseofhemodynamicparameters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)Today：現(xiàn)在：PACEP肺動(dòng)脈導(dǎo)管教育項(xiàng)目Outcomestudies結(jié)果研究Pursuitof“non-invasive”technology: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正常值Neonate新生兒Child兒童Adult成人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Neonate新生兒Child兒童Adult成人Waveform波形CatheterMaintenance導(dǎo)管維護(hù)ProblemswithPAcatheters/lines肺動(dòng)脈導(dǎo)管/線路使用的問題10．DerivedParameters衍生參數(shù)MeanArterialPressu