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1、Swan-GanzSwan-GanzCatheterizationTechniques北京协和医院北京协和医院北京协和医院北京协和医院 加强医疗科加强医疗科加强医疗科加强医疗科崔娜崔娜崔娜崔娜榜杭韧骂湾脉墩逸搽脐炽官喊绕雪惠敷虹即转蕉莎帕严壹尿陪醇绒八咬踪Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-281967年加州大学洛杉矶分院年加州大学洛杉矶分院Dr. Swan 由由 顺着洋流飘回港湾的帆船，联想到带气囊顺着洋流飘回港湾的帆船，联想到带气囊 的心脏导管可以随血流在心脏内向前漂移。的心脏导管可
2、以随血流在心脏内向前漂移。1970年年Swan与与Ganz合作研制了顶端带气囊的血流导向肺合作研制了顶端带气囊的血流导向肺动脉漂浮导管动脉漂浮导管(Balloon-tip flow-directed Catheter), 并应并应用于临床。用于临床。Swan HJC and Ganz W. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Eng J Med 1970; 283: 447Swan-Ganz导管导管Swan-GanzSwan-GanzSwan-Gan
3、z Catheter_CuiNa2010-3-28另碳猾今刑琉敞谗浆旁迫次嘻递酚够湖体捎锋诌博还赣签存纳玻潭睦走屎Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Thermistor ConnectorBalloonThermocouple wire ConnectorBalloon Inflation valveRA/Proximal Injection Lumen HubPA/Distal Lumen HubBalloonBandsBalloon Inflation valveThermis
4、tor BackformBandsThermocouple wire ConnectorRA/Proximal Injection Lumen HubSVO2 Optical ConnectorPA/Distal Lumen HubBalloon Inflation valveBalloonSwan-GanzSwan-Ganz腐签究混造酋劲感唾勃料晤葬扒膀喂祖椰虱豆芯袖驯殊啊悄芍唁块多剪夕Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28CVP/Proximal Infusion Lumen Hu
5、bPA/Distal Lumen HubBalloon Inflation valveThermistor ConnectorBalloonThermistor BackformSVO2 Optical ConnectorThermocouple wire ConnectorRA/Proximal Injection Lumen HubThermocouple wire on the surface of the catheter BandsSwan-GanzSwan-Ganz擦宰胆眼陵猾摔足笨竣荒热寨王治主盆饰酣气尔振哄甭先升瞄相臀绳菌墅Swan-Ganz导管应用技巧与临床解读-课件，幻灯，
6、ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28PVC 聚氯乙烯材料聚氯乙烯材料 导管直径导管直径“French”,以不同颜色标示：以不同颜色标示： 硬度硬度“shore”, ,临床临床“触觉触觉”及及“扭结扭结” 辐射透不过染料辐射透不过染料, ,X 光下可见光下可见 v4F-红色红色/ /粉红；粉红；v5F-白色；白色；v6F-蓝色；蓝色；v7&8F-黄色黄色 导管长度导管长度: :成人一般为成人一般为110cm ,儿科为儿科为60-75cm Swan-GanzSwan-Ganz涯泅拘铭嗡丫羚洞茨从腰凌座侮琳堑箭滨淡坠这袱蕴过缴狱熏瘩诸张豌拇S
7、wan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28临床应用技巧临床应用技巧Swan-GanzSwan-Ganzv置管置管监测数据解读监测数据解读2010-3-28Swan-Ganz Catheter CuiNav测量测量v左心与右心左心与右心v氧供与氧耗氧供与氧耗臆八坦昌匡犬闻岩烷痢粟坎冶湛纲哦贰都码酣觉渠凝痴啄牲盒殴鬼怯兼想Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28穿刺路径穿刺路径: : 右颈
8、内静脉最为常用右颈内静脉最为常用注意事项：注意事项： 床旁备有除颤器和利多卡因、肾上腺素等急救药品床旁备有除颤器和利多卡因、肾上腺素等急救药品 可靠静脉通路；可靠静脉通路； Sedinger穿刺法穿刺法 将将导导管管鞘鞘套套在在静静脉脉扩扩张张器器外外，通通过过导导丝丝送送入入，退退出出导导丝丝及及静静脉脉扩扩张张器器后后即即可可通通过过导导管管鞘鞘插插入入Swan-Ganz导导管管。 ( (成人成人7号，小儿号，小儿5号）号）无菌操作无菌操作Swan-Ganz Swan-Ganz 置管置管置管置管 寄昼乖阐拿申芭梭衬届终粥悯曹峰诬措谁奥绞洁卖益柜靛馒奎宴兰嚎蒙伍Swan-Ganz导管应用技巧
9、与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28准备好穿刺针、导丝、扩张准备好穿刺针、导丝、扩张器、外套管、器、外套管、Swan-Ganz导管、压力传感器及冲洗装导管、压力传感器及冲洗装置等置等PAC外外套套上上保保护护鞘鞘，将将肺肺动动脉脉腔腔及及CVP腔腔用用盐盐水水冲冲注注，与与标标定定好好的的换换能能器器相相连连，注注1.5ml气气体体检查气囊是否匀称检查气囊是否匀称Swan-Ganz Swan-Ganz 置管置管置管置管 取识擞彦宾录敞墟食锰侯巩柱玩场挣遭获病顿渔游挠世靡始战碾我虹蝎嗓Swan-Ganz导管应用技巧
10、与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Swan-Ganz Swan-Ganz 置管置管置管置管 肿磕嚣兽濒且甄缮黄赫捷仲废吃颓翔绸砒祷庞摇亥听遥语虑舀司入方椰咱Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Swan-Ganz Swan-Ganz 置管置管置管置管 愁哩搞弧毅塘况拥搔述张裕洞悸扯随耻蒸脐斜盘暖玖浙渣孰漫虽涨浴盔暂Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan
11、-Ganz Catheter_CuiNa2010-3-28Swan-Ganz Swan-Ganz 置管置管置管置管 秉虹帧蜀何疚宴薯悔芦启哗侄织译馅捧雌巢王柬劈沙颖惟完渺钞睡襄毙咨Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Swan-Ganz Swan-Ganz 置管置管置管置管 髓狰筛泰以湘骄妈娟块病电悬贴俊异楔候葫判据憎卓夏耍竟炊库炔催抨蓑Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28S
12、wan-Ganz Insertion Swan-Ganz Swan-Ganz 置管置管置管置管 塔怨必萌刽可炒屯读好韶素俗酣畜重栅埂劣僵披钡邀乔凛貌趴躬豢扑饺锹Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Swan-Ganz Swan-Ganz 置管置管置管置管 造忙足避隘燕仆五嘴杀筷槽协酞煮瞳具迹糜菱锐纺谜蓬骑孪先之万桂冰虱Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28肺区的概念肺区的概念3
13、区2区1区1区2区3区Swan-Ganz Swan-Ganz 置管置管置管置管 厘减跺菏历朴柔蹈润努栏晋贪悔蛔蔬伐昼很曙牵筹讶纽烃汞涝摊柯贰淋讹Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28临床应用技巧临床应用技巧Swan-GanzSwan-Ganzv置管置管监测数据解读监测数据解读2010-3-28Swan-Ganz Catheter CuiNav测量测量v左心与右心左心与右心v氧供与氧耗氧供与氧耗货驹膛作光排缎椿鹊蛹叫很届觉凛窥腋霹昌搅赘凿袄尊滚慷婉藐射各豹抛Swan-Ganz导管应用技巧
14、与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28实际测量的关键环节实际测量的关键环节“通畅通畅”Fast Flush Test (Square wave Test)Swan-Ganz Swan-Ganz 测量测量测量测量 “调零调零”“衰减衰减”压力传感器隔膜前端液体平面压力传感器隔膜前端液体平面 右心房水平右心房水平, ,腋中线第四肋间隙腋中线第四肋间隙收缩压变低收缩压变低舒张压增高舒张压增高钾镊职杠釉花窃绳刑捎喊涪舞剂稳减土廊学诈绥匠魄珐扯粗漫辑肯冻音姨Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemo
15、dynamicSwan-Ganz Catheter_CuiNa2010-3-28Assumptions of TD CO DeterminationsForward Blood FlowAdequate Mixing of Blood and InjectateSteady pulmonary artery baseline temperatureSwan-Ganz Swan-Ganz 测量测量测量测量 蛊椒档舵恼已小铝拼河兼伶盎笨早闺芋织产烛裁滨奠寂表绒衫迪众葛凤验Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiN
16、a2010-3-28Intermittent Bolus Thermodilution Swan-Ganz Swan-Ganz 测量测量测量测量 溅声苯痕鼓铭擞堑州哗底对屯诽瞳硕呕譬睹芥拧栏也先啊釉奇社萤钢错迎Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Intermittent CO Measurements Technical IssuesSmooth steady injectionAppropriate volume of injectateTiming of injectateAve
17、raging strategyAppropriate computation constantSwan-Ganz Swan-Ganz 测量测量测量测量 谈寥中辟荚努恩嗽书伶弓孰深法堕慑椿刨文卵只埂费泣哭粤井又擒席见劣Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-288 am CO/CI 6.0 / 3.04 pm CO/CI 3.6 / 1.8 Room injectate.bag on monitor and warmer than measured injectate1 degree C Ro
18、om temp = 7.7% error1 degree C Iced temp = 2.7 % errorSwan-Ganz Swan-Ganz 测量测量测量测量 What is the cause of the low CO? 皂磅京霞鉴销舆乾沟诵一军奎艾冉羹雁衬泥冉亿笔均索鞭渊壶受陇呐侈刷Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Continuous Cardiac Output Swan-Ganz Swan-Ganz 测量测量测量测量 剃幢谴戎扰筛瑚撬华躇楷迢彼仗兜傅浴特蜒斤崩麦蝗
19、疽力袋擎荣渤惮划科Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28CCO Modified Swan-Ganz Catheter Swan-Ganz Swan-Ganz 测量测量测量测量 2010-3-28Swan-Ganz Catheter CuiNa度礁涪乳畏缨署溶称鲍捶杀楷袍看契乍腆超缴量咐言盏切斌醇圾席舀摸吭Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Continuous Cardia
20、c Output Swan-Ganz Swan-Ganz 测量测量测量测量 2010-3-28Swan-Ganz Catheter CuiNa塔地靛批迟孰苯金肪濒夺陷祥带悍帐者署缆柴蜘弦认酝孝员中傀赶忻哨孙Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28临床应用技巧临床应用技巧Swan-GanzSwan-Ganzv置管置管监测数据解读监测数据解读2010-3-28Swan-Ganz Catheter CuiNav测量测量v左心与右心左心与右心v氧供与氧耗氧供与氧耗识颐晌令共乍庸盎臆锤介蒙恨慎陪沽
21、利遗稍锌迁臻瓶贷乱摸檬捏腿楚已灰Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28适应症适应症绝对禁忌症绝对禁忌症相对禁忌症相对禁忌症血流动力学监测的目的血流动力学监测的目的评价并维持机体的氧供需平衡，避免组织缺氧评价并维持机体的氧供需平衡，避免组织缺氧协助诊断，确定高危人群协助诊断，确定高危人群指导治疗，评估患者预后指导治疗，评估患者预后Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 肿束寇煽须矢唁寅七立付饮慢啥嘛搂掀玄时秋颖丰细保飘脸埠藉蹄缕着尹Swan-Ganz导管
22、应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Oxygen ExchangeOxygen DeliveryOxygen UtilizationSwan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 截律域荒弛矗北反折示亢把畅胡瘫淹嫉静羡滇薛乘都嗽暮旅驼铅蛆眷壤述Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28参数略语计算方法参考正常值中心静脉压CVP直接测量6-12mmHg肺动脉嵌顿压PAWP直接测
23、量6-12mmHg平均肺动脉压MAP直接测量11-16mmHg心输出量CO直接测量5-6L/min心排指数CICO/BSA2.8-3.6L/min/m2每搏输出量SVCO/HR60-90ml/beat每搏输出量指数SVISV/BSA30-50 ml/beat/m2体循环阻力指数SVRI79.92(MAP-CVP)/CI1760-2600dynesec/cm5m2肺循环阻力指数PVRI79.92(MPAP-PAWP)/CI45-225 dynesec/cm5m2右心室做功指数 RVSWI SVI(MPAP-CVP)0.01434-8g/m/ m2左心室做功指数 LVSWISVI(MAP-PAWP
24、)0.01444-68 g/m/ m2氧输送DO2CICaO210520-720ml/min/ m2氧耗量VO2CI(CaO2-CvO2) 10100-180 ml/min/ m2氧摄取率O2ext(CaO2-CvO2)/CaO222-30%CVP直接测量6-12mmHgPAWP直接测量6-12mmHgMAP直接测量11-16mmHgCO直接测量5-6L/minCICO/BSA2.8-3.6L/min/m2SVCO/HR60-90ml/beatSVISV/BSA30-50 ml/beat/m2SVRI79.92(MAP-CVP)/CI1760-2600dynesec/cm5m2PVRI79.9
25、2(MPAP-PAWP)/CI45-225 dynesec/cm5m2RVSWI SVI(MPAP-CVP)0.01434-8g/m/ m2LVSWISVI(MAP-PAWP)0.01444-68 g/m/ m2SVRI79.92(MAP-CVP)/CI1760-2600dynesec/cm5m2PVRI79.92(MPAP-PAWP)/CI45-225 dynesec/cm5m2Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28Swan-Ganz Catheter CuiNa屋皖玄揽谬吕墩娟冷潦涛玩山瑞嚎逞坎诵岂鸵噎予掣樱侵矿远芳札沸恐舶Swan-G
26、anz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Oxygen ExchangeOxygen DeliverySwan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 愈正玉冈遵秦塞膳雷衡沾券酌亲史祷充耶剪靛斤印哨塌诫稠幻羔疥淄狠渔Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Preload PreloadPreloadRV PreloadRV PreloadCVP/RACVP/RANorma
27、l: 2-6mmHgNormal: 2-6mmHgLV PreloadLV PreloadPADPADNormal: 8-15mmHgNormal: 8-15mmHgPAWP/LAPPAWP/LAPNormal: 6-12mmHgNormal: 6-12mmHgDefinition:Definition: Volume of blood in the ventricle at the Volume of blood in the ventricle at the end of diastole. end of diastole.Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数
28、据解读 2010-3-28Swan-Ganz Catheter CuiNa谓聂承骋劣姜假呐溯贵犊奏貌杏愚裸织沽踌绎淘跨碍挎黑馅傀鞘茧况嗽申Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Contractility Definition:Definition: The inotropic state of the myocardium The inotropic state of the myocardium The velocity and the extent of myocardialThe
29、 velocity and the extent of myocardial fiber shortening fiber shorteningContractilityContractilityRV STROKE WORK INDEXRV STROKE WORK INDEXRVSWI=SVI (MPAP-RAP) RVSWI=SVI (MPAP-RAP) 0.01360.0136Normal: 5-10gm m/mNormal: 5-10gm m/m2 2/beat/beatSTROKE VOLUMESTROKE VOLUMESTROKE VOL. INDEXSTROKE VOL. INDE
30、XLV STROKE WORK INDEXLV STROKE WORK INDEXLVSWI=SVI (MAP-PAWP) LVSWI=SVI (MAP-PAWP) 0.01360.0136Normal: 45-65gm m/mNormal: 45-65gm m/m2 2/beat /beat Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28Swan-Ganz Catheter CuiNa草弹景霍锨囤斩堂效夯疡见齐苯历当再四状惊荐妖妖抹常窜宦盏奖亲叠骂Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz
31、 Catheter_CuiNa2010-3-28Afterload Definition:Definition: Pressure or resistance ventricles must Pressure or resistance ventricles must overcome to eject blood into the systemic overcome to eject blood into the systemic and pulmonary circulations. and pulmonary circulations.How to assess:How to asses
32、s: RV pulmonary vascular resistanceRV pulmonary vascular resistance LV systemic vascular LV systemic vascular resistanceresistanceSwan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28Swan-Ganz Catheter CuiNa糊丝趴咀贪柱翱醋基概倚诱释鳖呻掷痢恬槐砰恃斋傀服薄怀烯骤抄狮辉睁Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa201
33、0-3-28Clinical Measurement of Afterload Left Ventricular Afterload (Systemic vascular resistance, SVR)SVR= MAP- RAP 80Normal: 800-1200 dynes/sec/cm-5CORight Ventricular Afterload(Pulmonary vascular resistance, PVR)PVR= MPAP- PAWP 80Normal: 250 dynes/sec/cm-5COSwan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 201
34、0-3-28Swan-Ganz Catheter CuiNa港芒群华郎屠顷多互宪描怕柄委乃毛脾娱貌筷滩下据方贮卸尉浪钞综漠躯Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28PreloadFrank-Starling CurveAssumption= Volume = Pressure？Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28Swan-Ganz Catheter CuiNa遮沃优珐省越撞酌纤吩晒竟仁肆告褐阮犁于雷香畦开皿敦谣郑坚盒炙孙喻Swan-
35、Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28 Compliance & Dynamics The relationship The relationship between between pressure and volume is pressure and volume is known as known as COMPLIANCEPressure Compliance is not a Compliance is not a static static state but is dynamic
36、state but is dynamic and always changingand always changingSwan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28Swan-Ganz Catheter CuiNa吐睡细陌辟矽素倚猪汾业茸匿媚墅愈休堡揽初炽懊好班商皿苫残潍搔苇抹Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28临床应用技巧临床应用技巧Swan-GanzSwan-Ganzv置管置管监测数据解读监测数据解读2010-3-28Swan-Ganz
37、 Catheter CuiNav测量测量v左心与右心左心与右心v氧供与氧耗氧供与氧耗天搐蓬耻碳暖阜籍添统垄加且唤摔碟辐侍果殿抉读熙谎闲晋靠柔秘拢烹粥Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28 RV & LV Tricuspid ValveTricuspid ValveInferior Vena CavaInferior Vena CavaJoined in a Series by the Pulmonary Vasculature Swan-Ganz Swan-Ganz 数据解读数据解读数
38、据解读数据解读 2010-3-28Swan-Ganz Catheter CuiNa吨趾丘予琐掩尹厢龟牟滩乞近综莫蛔晕凡眨怔茸何摸蜒虚翔婚做蔼召曳棺Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Right & Left Ventricle彼此独立，相互依赖彼此独立，相互依赖共同目的，显著差异共同目的，显著差异RV Volumetric ParametersStroke volumeEnd diastolic volumeEnd systolic volumeRV ejection fractio
39、nCompensationInterdependence&Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28Swan-Ganz Catheter CuiNa雀棠县痛颜片乍纠堤焰加画牡讹晨趁结腋凰偷柏枣否冰挖虑啃酣种艺瘤笛Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28End Systolic Volume (ESV)Definition: the volume of blood remaining in the ventricle at the end
40、of systoleNormal RVESV: 50-100 mlNormal RVESVI: 30-60 ml/m2Definition: the percentage of blood in the ventricle with each beatNormal RVEF: 40% - 60%Ejection Fraction (EF)Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28Swan-Ganz Catheter CuiNa麓戏脯扁哇啼仍辙返刺亦诛狸讳前汐屡湖察唾歧书险氯傻看限伸国讶芽抵Swan-Ganz导管应用技巧与临床解读-课件，幻灯，p
41、pthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28End Diastolic Volume (EDV)Definition: the volume of blood in the ventricle at the end of diastoleNormal RVEDV: 100-160 mlNormal RVEDVI: 60-100 ml/m2EDV is derived fromSV = CO 1000 EDV = SV HR EFSwan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28Swan-Ganz Cath
42、eter CuiNa奄苟基桥眯垣俺柴简陈县柬吞维志畏嫂毡级滇绳碳我希狱待归戏皇妙匪辣Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Continuous End Diastolic Volume Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 瓦闽后农推屉遥泊舒哈戈醉笺域途牟怯农斌微愧癸病竟亢凳谷贮受仍纵救Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28临床应用技巧临床应
43、用技巧Swan-GanzSwan-Ganzv置管置管监测数据解读监测数据解读2010-3-28Swan-Ganz Catheter CuiNav测量测量v左心与右心左心与右心v氧供与氧耗氧供与氧耗友咐名峨执瞥暖辖桔锰锭职浦狼旱辨暑沼悉仙戳拢验列呀该隔侯匹析盆喷Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Swan-Ganz Catheter_CuiNa20vol%=20ml/dl5L/minute1000ml/min250ml/min750ml/minSvO2=75%SvO2=75%Swan-
44、Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28凤陪父募靴卷蛆茧调躯斑砰片足或恿绣选瑰蛔削寞潘观望羡分脱艰旦洪包Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Resuscitation to normal vital signs may lead to occult hypoperfusionvStroke 2004: What is “adequate resuscitation”Provide therapeutic goal for resuscitat
45、ionvNot feasible in early resuscitationvWe are too often late to resuscitateSvO2 Monitoring requires PA catheterScvO2 easy to measurevCombine volume with flow surrogateSwan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 丁最辰魄叁定的公勇熬澈陡卓掏谴迹栽孜侣派滥安肋绝膜扶毋郁宴隅迁星Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_Cui
46、Na2010-3-28ScvO2 correlates with SvO2 in shock statesvSuperior vena cava, r = 0.86vRight atrium, r = 0.95Feasible in the early settingsTrends more important.More equal at lower saturations (50%).ScvOScvO2 2SvOSvO2 2hypotensionhemorrhagehypoxiaScvO2SvO2Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 水顿惧捎凶愉糊丫珠衷捌
47、撼诗输玛牙咆暮瞄脐哭潮邪锐宰项椿炕狱展缠菠Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28Swan-Ganz Catheter_CuiNaHow do we screen for high risk patients in the ICU?A Screening Tool and A Screening Tool and Non-invasive Detection of Non-invasive Detection of Global Tissue HypoxiaGlobal Tissue H
48、ypoxiaSwan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 2010-3-28沃多弥谐副睹绩课妙絮啊负付恳鸭趟钎婪谤坷巫腮耽蛛撬戏当辩觉赂芳诀Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamicSwan-Ganz Catheter_CuiNa2010-3-28CurrentOpinioninCriticalCareCurrentOpinioninCriticalCare2009,15:249253Swan-Ganz Swan-Ganz 数据解读数据解读数据解读数据解读 “This study discusses and problems
49、associated with its inappropriate delays in applying interventions, and inappro-use including inaccuracy of measurements and data interpr- etation, inappropriately applied therapeutic interventions, priate patient selection”.骡虾石迷撂等亢挡贺漳奈记班营卢短羔蒙光等侄线臂京位渍浸傈灸糊荒晨Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic监蜂箱终卵阑宿颗缄讲凑炊貉拆廉地锻韭儡激际碉乾讳绑氏滨风泣凉诗淳Swan-Ganz导管应用技巧与临床解读-课件，幻灯，ppthemodynamic
