cvp深静脉置管术课件篇.pptVIP

* * 并发症（1） 中心静脉穿刺引起的并发症 误入动脉 血肿 神经损害 气胸 气栓 * 并发症（2） 插管过程中引起的并发症 一般心律失常 严重心律失常（室速、室颤） 右束支传导阻滞 完全性传导阻滞（主要指原有RBBB） * 并发症（4） 导管扭曲、打结、折断 心脏机械性损伤 * Table 7 PRACTICE GUIDELINES FOR PULMONARY CATHETER USE ( ASA TASK FORCE ON PULMONARY ARTERY CATHETERIZATION ) Opinions PA catheter monitoring can reduce the incidence of perioperative complications,primarily by providing immediate access to critical hemodynamic data Having immediate access to PA catheter data allows important preemptive measures for that subset of patients who encounter hemodynamic disturbances that require immediate and precise decisions about fluid management and drug treatment. Experience and understanding are the major determinants of PA catheter effectiveness PA catheterization is inappropriate as a routine practice in surgical patients and should be limited to cases in which the anticipated benefits of catheterization outweight the potential risks. * Table 8 PRACTICE GUIDELINES FOR PULMONARY  CATHETER USE ( ASA TASK FORCE ON  PULMONARY ARTERY CATHETERIZATION ) Recommendations perioperative PA catheterization should be considered in surgical settings associated with an increassed risk because of complications from hemodynamic changes. PA catheterization is not recommended when the patient,procedure,and practice setting each pose a low risk for hemodynamic changes. Due to the risk of complication from PA catheterization,the procedure should not be performed by clinicians who lack competence in safe insertion or in accurate interpretation of result. * 海湾的故事 * * * 表现： a.突发呼吸困难 b.右室流出道阻塞，CO下降，缺血、缺氧 诊断： a.应与心律失常，大面积肺栓塞，急性心梗， 心包填塞区别 b.心尖部可闻及水轮样杂音 c.超声波检查有助于诊断 * 处理： a.左侧头低位，通过导管抽吸空气 b.经皮行右室穿刺抽气 c.急诊行体外循环 * 4．心包填塞：不常见，国外34例中死亡率  为70％，好发于右房44％，右室36％ 原因： a.置管过深 b.导管质地较硬，不光滑，钝园 c.心脏原有病理性改变 * 表现： a.突发紫绀，颈静脉怒张，恶心，胸骨后疼痛， 呼吸困难 b.低血压、脉压变窄、奇脉、心音低远 急救： a.立即中止经深静脉导管注输 b.将CVC输注器的高度降