急危重癥的監(jiān)護(hù)ppt課件(編輯修改稿)
2025-04-18 06:11 本頁面
【文章內(nèi)容簡介】 The ECG reading demonstrates a rapid, polymorphic ventricular tachycardia with a characteristic twist of the QRS plex around the isoelectric baseline. It is also associated with a fall in arterial blood pressure, which can produce fainting. 42 Characteristic tracing showing the twisting (blue line) of a torsade de pointes 43 Lead II electrocardiogram showing Torsades being shocked by an Implantable cardioverterdefibrillator back to the patients baseline cardiac rhythm. 44 Acute Myocardial Infarction 45 2. 血壓監(jiān)護(hù)（ Blood Pressure monitoring ） ? Related to both cardiac function and the peripheral circulation ? Standard and universal for critically ill patients ? BP does not reflect cardiac output (CO) – BP can be high with a low CO if vasoconstriction occurs and vice versa 46 ? Can be measured intermittently with a cuff or continuously with an arterial line ? An additional use of arterial catheterization is to provide access for arterial blood sampling. This is often indicated in patients who require frequent sampling of blood for arterial blood gases or other blood tests. 47 中心靜脈壓 （ central venous pressure ） ? Be inserted via the subclavian, internal jugular ? provide estimates of central venous pressure (CVP) and measurement of central venous oxygen saturation (ScvO2) ? CVP reflects the balance between systemic venous return and cardiac output ? Have difficulty to assess leftsided preload (only secondarily reflects changes in pulmonary venous and leftsided pressures ) 48 鎖骨下靜脈穿刺示意圖 49 頸內(nèi)靜脈穿刺示意圖 50 視頻 1 51 中心靜脈壓 血壓 提示意義 降低 降低 有效血容量不足 升高 降低 心功能不全 升高 正常 容量負(fù)荷過重 進(jìn)行性升高 進(jìn)行性降低 嚴(yán)重心功能不全 ， 或心包填塞 正常 降低 心功能不全或血容量不足， 可予補(bǔ)液試驗 。 中心靜脈壓與血壓之間關(guān)系 52 3. 血氧飽和度（ Pulse oximetry ） ? Affords a noninvasive estimate of arterial oxygen saturation ? A standard of care in many institutions ? The reliability of this method may be limited in patients with severe hypoxemia, abnormal arterial pulsations, and hypoperfusion of the site of measurement 53 Clinical Applications ? Adjusting inspired oxygen, during weaning from mechanical ventilation ? Testing different levels of PEEP, inverse I:E ratio, or other mechanical ventilator adjustments ? Monitoring during procedures such as bronchoscopy, gastrointestinal endoscopy, cardioversion, hemodialysis 54 4. 肺動脈插管 Pulmonary Artery Catheterization ? Monitoring CVP ? Provides information related to left heart filling pressures ? Allows sampling of pulmonary artery blood for determination of mixed venous oxygen saturation. ? Thermodilution cardiac output measurements are made using a thermistortipped catheter. 55 56 57 pulmonary capillary wedge pressure (PCWP) ? Estimates l
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