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当代肺动脉导管。第 2 部分:测量、局限性和临床应用。

The contemporary pulmonary artery catheter. Part 2: measurements, limitations, and clinical applications.

机构信息

Department of Intensive Care, Medical Center Leeuwarden, Henri Dunantweg 2, P.O. Box 888, 8901, Leeuwarden, the Netherlands.

Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

出版信息

J Clin Monit Comput. 2022 Feb;36(1):17-31. doi: 10.1007/s10877-021-00673-5. Epub 2021 Mar 1.

Abstract

Nowadays, the classical pulmonary artery catheter (PAC) has an almost 50-year-old history of its clinical use for hemodynamic monitoring. In recent years, the PAC evolved from a device that enabled intermittent cardiac output measurements in combination with static pressures to a monitoring tool that provides continuous data on cardiac output, oxygen supply and-demand balance, as well as right ventricular performance. In this review, which consists of two parts, we will introduce the difference between intermittent pulmonary artery thermodilution using bolus injections, and the contemporary PAC enabling continuous measurements by using a thermal filament which heats up the blood. In this second part, we will discuss in detail the measurements of the contemporary PAC, including continuous cardiac output measurement, right ventricular ejection fraction, end-diastolic volume index, and mixed venous oxygen saturation. Limitations of all of these measurements are highlighted as well. We conclude that thorough understanding of measurements obtained from the PAC is the first step in successful application of the PAC in daily clinical practice.

摘要

如今,经典肺动脉导管(PAC)已经有近 50 年的临床应用历史,用于血流动力学监测。近年来,PAC 已经从一种能够间歇性测量心输出量并结合静态压力的设备演变为一种监测工具,它可以提供心输出量、氧供需平衡以及右心室功能的连续数据。在这篇由两部分组成的综述中,我们将介绍间歇式肺动脉热稀释法(通过推注测量)与现代 PAC (通过热丝连续测量)之间的差异,热丝会加热血液。在第二部分中,我们将详细讨论现代 PAC 的测量,包括连续心输出量测量、右心室射血分数、舒张末期容积指数和混合静脉血氧饱和度。还强调了所有这些测量的局限性。我们的结论是,彻底了解从 PAC 获得的测量值是在日常临床实践中成功应用 PAC 的第一步。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/74c5/8894306/11e92cc47eda/10877_2021_673_Fig1_HTML.jpg

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