Pre-ICU-trainingCV-CR-萧智忠培训课件.pptVIP

Indication Bradycardia with symptom and refractory to medication 病人如有bradycardia , high degree AV block with unstable BP 應放置TCP 並call duty CR 評估是否放置TPM 病人放置PPM或曾施行CVP puncture , 如Ablation 應f/u CXR 注意有無pneumothorax,位置是否正確,有無移位並f/u EKG注意是否有相應的變化 精品文档 Swan-ganz 精品文档 Indication Shock D/D Pulmonary artery catheter 可幫助鑑別cardiogenic or no-cardogenic shock , 區別pulmonary edema or ARDS, 病人如有上述情形應考慮置放Pulmonary artery catheter 以為鑑別, 亦可當作治療指標 Monitor fluid and C/O and adjust medication Swan-Gan會開立固定測量時間(q6h,q8h),但如果病情有需要即應及時測量 精品文档 肺動脈導管 臨床應用 精品文档 導管介紹 肺動脈導管pulmonary Artery catheter 一般稱為Swan-Ganz catheter，全長110cm ，其尖端為一可充氣之球體，可隨血流漂動至右心房，右心室再到肺動脈處，來測得病人血液動力學上的一些壓力數值 精品文档 CCOmbo VolumetricsPulmonary Artery Catheter ??????????????? Continuous Right Ventricular End Diastolic Volume (RVEDV) and Right Ventricular Ejection Fraction (RVEF)? measurements. Swan-Ganz CCOmbo Pulmonary Artery Catheter ??????????????? Swan-Ganz Continuous Cardiac Output, Mixed Venous Oxygen Saturation monitoring (CCO/SVO2)pulmonary artery catheter Thermodilution Catheter and IntroFlex Sheath with No Latex Components ??????????????? Swan-Ganz Catheter with Non Latex?components for assessment of right heart pressures, cardiac output 精品文档 Lumen Distal lumen---- 可測得肺動脈壓、肺楔壓及可由此抽取混合靜脈血 Balloon--離遠端1cm，可充氣放氣，在放置過程隨血流飄進 Proximal lumen—在導管30cm處，可測得右心房之壓力 溫度感應器----藉以測出血液溫度變化，進而算出心輸出量 混合靜脈血氧飽和度mixed venous oxygen saturation(SVO2) 代表身體氧氣供應消耗的平衡狀態 連續性心輸出量continues cardiac output (CCO) 精品文档 目的 間接監測左心室舒張末期的壓力(LVEDP)，做為輸液指標，確知病患有無心衰竭、肺水腫情形 測知左心室填充情形 測量心輸出量，評估左心室功能 抽血、右心房SVO2，肺動脈-混合靜脈血，可診斷心室中隔缺損(VSD)等疾病 精品文档 Indications Diagnostic Diagnosis of shock states Differentiation of high- versus low-pressure pulmonary edema Diagnosis of primary pulmonary hypertension (PPH) Diagnosis of valvular disease, intracardiac shunts, cardiac tamponade, and pulmonary embolus (PE) Monitoring and management of complicated AMI As