【正文】 ce and is probably considered the clinical haemodynamic “gold standard“.,第二十頁，共八十一頁。多普勒超聲技術(shù)測量左心室充盈期舒張末面積直接與每搏容量指數(shù)相關(guān), 可作為前負(fù)荷的定量指標(biāo)。70% 多數(shù)(duōsh249。 CO = Vavg ? Area ao ? Tei ?HR area ao升主動脈橫截面的面積值 HR心率 Vavg每搏的平均流速 Tei射血時間,第十八頁，共八十一頁。)頻率之間的差異。,〔三〕多普勒心排血量監(jiān)測(jiān c232。,Echocardiogram An echocardiogram is a test in which ultrasound is used to examine the heart.,第十六頁，共八十一頁。)壁運(yùn)動異常〔RWMA〕等。,Echocardiogram,臨床上有M型超聲心動圖、二維超聲心動圖及多普勒超聲心動圖及經(jīng)食管超聲心動圖。,第十三頁，共八十一頁。j236。,第十二頁，共八十一頁。 ICG 由于其抗干擾能力差, 易受病人呼吸、心律失常及手術(shù)操作等的干擾, 尤其是不能鑒別異常結(jié)果是由于病人的病情變化引起, 還是由于機(jī)器本身的因素所致,其絕對值有時(yǒush237。,ICG是一項無創(chuàng)傷性的方法，操作簡單、費(fèi)用低、平安。7180。,Philips Impedance Cardiography (ICG) continuously measures hemodynamic parameters without the associated risks of traditional invasive methods. The Philips ICG measurement is ideal for hemodynamic evaluation of adult patients in: Emergency departments Stepdown units Special procedure,第十頁，共八十一頁。,第八頁，共八十一頁。,Impedance cardiography (ICG) is a safe, noninvasive method to measure a patient39?！鱖/sec)/Zo,第五頁，共八十一頁。 SV=(Vept 1981年Sramek提出胸腔是錐臺型，因此改進(jìn)了Kubicek 公式，應(yīng)用8只電極分別安置在頸根部和劍突水平，測量心動周期胸部電阻抗的變化來測定左心室收縮時間〔systolic time interval,STI)和計算每搏量,通過(tōnggu242。ng)血流圖,其根本原理是歐姆定律(電阻=電壓/電流)。n)無創(chuàng)心排血量測定,第四頁，共八十一頁。r yǎng hu224。,一、無創(chuàng)血流動力學(xué)監(jiān)測(jiān c232。,血流動力學(xué)監(jiān)測是臨床危重病急救的重要內(nèi)容之一，是大手術(shù)和搶救危重病員不可缺少(quēshǎo)的手段。,History of Monitoring,1960s: golden age of vasopressors Pressure arterial line amp。nɡ d233。血流動力學(xué)監(jiān)測(jiān c232。)進(jìn)展,浙江省立同德(t243。)醫(yī)院ICU 陳揚(yáng)波,第一頁，共八十一頁。 CVP 1970s: golden age of inotropes Cardiac output, PA catheter 1980s: SvO2 , relative balance between oxygen supply and demand 1990s till now: Better understanding of tissue oxygenation, right ventricular function Functional monitoring, PiCCO, continuous CO Less invasive, TEE,第二頁，共八十一頁。 無創(chuàng)傷性血流動力學(xué)監(jiān)測〔noninvasive hemodynamic monitoring〕 創(chuàng)傷性血流動力學(xué)監(jiān)測〔invasive hemodynamic monitoring〕,第三頁，共八十一頁。),〔一〕心阻抗血流圖〔Impedance cardiogram, ICG〕 〔二〕超聲心動圖〔 ultrasonic cardiogram, echocardiogram, UCG〕 〔三〕多普勒心排血量監(jiān)測 〔四〕二氧化碳(232。 t224。,〔一〕心阻抗(zǔk224。 1966年Kubicek采用直接式阻抗儀測定心阻抗變化, 推導(dǎo)出著名的Kubicek 公式。)微處理機(jī)，自動計算CO,并演算出一系列心功能參數(shù)。T,Figure１: Application of electrodes in impedance cardiography,第六頁，共八十一頁。s hemodynamic status. The ICG waveform is generated by thoracic electrical bioimpedance (TEB) technology, which measures the level of change in impedance in the thoracic fluid. Four small sensors send and receive a low amplitude electrical current through the thorax to detect the level of change in resistance in the thoracic fluid. With each cardiac cycle, fluid levels change, which affects the impedance to the electrical signal transmitted by the sensors.,The technology behind ICG,第七頁，共八十一頁。,Figure 7: Variation of ventricular, aortic and atrial pressure, aortic flow, thoracic impedance change and fist derivative of impedance (dz/dt) as a function of time (t). ECG and phonocardiogram taken simultaneously is also shown. The curve depicts the cardiac events / performance. B – Opening of the Aortic Valve, X – Closure of the Aortic Valve, Y – closure of pulmonary valve, O – mitral valve opening/rapid ventricular filling, BX – Ventricular Ejection Time (VET), C – Maximal deflection of dz/dt (Peak Flow), BC slope – Acceleration Contractility Index, A – Atrial Systole, Q – Start of ventricular depolarization,第九頁，共八十一頁。,Using ICG for the appropriate patient population The ICG measurement is designed for assessment of most adult patients – height 122229 cm (4180。6?) and weight 30159 kg (67350 lb) – but may demonstrate r