Arterial and Central Venous Pressure Monitoring （动脉和中央静脉压监测）.pdfVIP

Arterial and Central Venous Pressure Monitoring James A. L. Pittman, MD, BSc, FRCA John Sum Ping, MD, FRCA Jonathan B. Mark, MD “… the information that the pulse affords is of so great importance and so often consulted, surely it must be to our advantage to appreciate fully all it tells us, and draw from it every detail that it is capable of imparting.” F. A. Mahomed, 18721 The pulsatile arterial pressure wave is a fundamental clinically monitored variable that is used commonly to determine heart rate and rhythm and to provide the principle cardiovascular parameter indicative of adequate tissue perfusion. Detailed analysis of the pressure wave reveals that it has more to offer than this, and careful observation of its more subtle char- acteristics can provide additional useful diagnostic information. It is there- fore surprising that it is given so little attention. There is a similar ten- dency to overlook the added information obtainable from close analysis of the central venous pressure (CVP) waveform. In both measurements, cli- nicians tend to concentrate on the numeric values rather than the more qualitative data that are available. The shape and timing of the pressure waves and the changes that occur during the respiratory cycle should not be overlooked. In the first half of this chapter, we describe how some additional clinically important information can be obtained easily from close study of the arterial pressure waveform. The second part of the chapter has a similar focus on the CVP wave. We begin by identifying some technical considerations relevant to all pressure monitoring that are necessary to ensure that the high-resolution monitoring displays now available in the operating room and intensive-care unit can be readily and correctly used for this purp