Fick?

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??????????
2

• ???????
• ????????????????
• ????????????????
• ??????
• 1????????????????????????????????,?????????,?????
  ????????????
• Fick?
• ?????
•  ????
• 2????
• 3??????????

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Fick???????

• ???????,????????
• Q(dV/dt) / (Ca-Cv)?
• dV/dt??????,??????????????????,?????????????Cv???
  ??????

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(No Transcript)
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?????
6
????????????

• ?????????????????
• ???????????????,???????Swan-Ganz????(????????????
  ?????????)??????

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????
Swan-Ganz????(???????????????????)
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?????????????????????
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??????????

• ???????????????,???????Swan-Ganz??????????????????
  ?,??????????????????Stewart-Hamilton????
• ???1.08??????????????????????,b0???????,????60,CT?
  ?????????????????,??????,????????,Vi?Ti??????????(
  ?)???(?),Tb??????????????(?),Tb
  ??????????????????????0-4?????,???19-25??????

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????(impedance cardiogram ,ICG)

• ?????????????,????????????????????????????????????
  ?
• ?50 ???Nyboer ??????????????????????????????1969?K
  ubicek ??????????????????????(Kubicek
  ??),?????????????
• 70???,??????Kubicek ????????????,???????ICG???,???
  ??Kubicek ???????????????????

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?????????
Impedance Volume Measurement

• ? is the resistivity of blood
•  L is the distance between measuring electrodes
•  R is the resistance measured between electrodes.
• ?R , change in impedance over a cardiac cycle
  from end-diastolic volume to end-systolic volume
  (?R ltlt R )

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• ????????????CO,????????CO,???????????CO??????,????
  ??????????????????????????????????????????????????
  ?
• ??????????????????3,????????,???????????????,???
  ???????

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?????????

• ???????????(Oesophageal Doppler)
• ??????????(PartialCO2 Rebreathing)
• ???????

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Oesophageal Doppler
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????????
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??????PiCCO?? --Pulse Contour
Cardiac Output
The Transpulmonary Thermodilution
Technique (???????)
The Pulse Contour Analysis (???????)
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?????
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???????????

• ?????????????????,????????????????????????????PCW
  P(????6-12mmHg,?0.8-1.6kPa)????????????????
• ???????????
• ?????
• ???????????
• ??

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???????

• ????????????,????(SV),????70ml?
• ????????????????,????4-8L/min
• ?????(CI)??????????????,???2.5-4.0Lmin-1m-2?
• ??????????????????,????40-60ml beat-1m-2 ?
• ???????????????(EDV)??,????60-80
• ??????(TPR)??????????????,??????,???80????????900
  -1500dyn.s.cm-5?
• ????????????????????????,???80????,???50-150dyn.s
  .cm-5?

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??????????
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????????????
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????????????
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????????????
24
????
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???????(LambertBeer Law)

• ??????????????,????I?????I0???????
• I I0ekCd
• I?I0???????????D,?????????
• DIn(I/I0)kCd
• C???(????)???, d?????????, k??????????????? d
  ??,?????????? D????

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????HbO2?Hb
????HbO2?Hb??????????????? ????600-700nm???(RED)?
, Hb???????HbO2?? ????8001000nm????(IR)?,
Hb???????HbO2?? ?805nm????????
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?????????????
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????????????
SaO2 KlR2 K2R K3 K1?K2?K3?????, R??????????
??,??????????????,? R ?RED/?IR
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??LED????? (1)??LED?? (2)LED??,???LED??(3)??
LED???. ?????480?/?(??60Hz???????)?4O0?/?(5OH7???
)???????,???????????? ???LED???????,?????????????
,??????????????,????????
??
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??????????????

• ?????????????,????????????????????
• ?????????????????????,????????????????
• ????????????,???????????????
• ??????

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???????????
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?????????

• ???????????,???????????????
• ???(side stream)
• ???(main strean)

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??CO2?????????

• ??I,?????????????,???????????
• ??II,????????????PCO2??????

• ??III,??????????,?????,?????????????????,???????PE
  TCO2?