理解临床血流动力学(双语).pptVIP

From Physics : V = I x R Substituting produces: BP – Pra = Qt x SVR 物理学：V = I×R 替代公式：BP – Pra = Qt×SVR Hypoperfusion (shock) can arise from: - low cardiac output - low SVR - the combination of a low cardiac output and high SVR 灌注不足（休克）可由以下因素引起： ●低心排 ●低SVR ●低排高阻（低心排和高体循环阻力） Systolic pressure variation is useful as a guide to the management of the patient in shock in another way: patients with minimal or no variation in the blood pressure and pulse pressure are very unlikely to respond to volume administration. 另一方面，对休克患者进行管理时，收缩压变异度为一个非常有用的指标：患者血压和脉压出现极小或无变异时，几乎不可能对容量治疗作出反应。 The initial efforts to resuscitate such patients should therefore be directed at pharmacologic or mechanical interventions, which are much more likely to be effective. Because this strategy minimizes the unnecessary administration of fluid to critically ill patients, it may improve outcomes. 因此，对此类患者进行复苏时，最初的努力应着眼于使用药物或机械方法干预，这样或许会更有效。由于该方案最大限度的减少了对危重患者实施的不必要的液体治疗，因而可能会改善预后。 What doesn’t fit? Most patients with hypovolemic shock, LV shock, and sepsis respond to appropriate therapy. Failure to respond should raise red flags, and drive an evaluation for obstructive shock. 大多数低血容量性休克、LV休克（左心室相关性休克）以及败血症患者对恰当的治疗均有反应。对于无反应者，应该停止治疗并评估是否发生阻塞性休克。 Obstructive shock is shock caused by an obstruction to venous return. Obstructions to venous return are often insidious. While volume resuscitation and therapy with vasoactives might produce a transient minor improvement in the circulation, the definitive treatment consists of relieving the obstruction if this is possible. 阻塞性休克由静脉回心受阻引起。静脉回心受阻一般较为隐匿。虽然容量复苏和应用血管活性药物治疗可能会产生短暂轻微的循环改善，但如果可能，恰当的治疗应当包括减轻静脉回心阻力。 Causes of Obstructive Shock (Obstructions to Venous Return) - pericardial effusion - restrictive pericardium - tension pneumothorax - high levels of PEEP or intrinsic PEEP - massive pleural effusion - abdominal tamponade - venous occlusion (clot, air, tumor, pregnancy) - atrial occlusion (clot, air, tu