心排血量监测(7)
三、心排血量监测的临床意义
(一)监测心泵功能
心排血量前负荷、后负荷、心肌收缩性、每搏量和心率决定，如前负荷降低、后负荷增加，心肌收缩力减弱，则每搏量减少，如心动过速或过缓以及心律失常均可引起心排血量减少。因此，心排血量可以反映心泵功能。
(二)心血管参数计算
1、血流动力学指标正常值(表)
2、氧供需平衡指标
(1)氧供(DO2) DO2=CO×CaO2×10=CO×Hb×1.38×SaO2，正常值：1000ml/min(700～1400ml/min)或每平方米600ml/min。
(2)氧耗(VO2) VO2=(CO×CaO2×10)-(CO×CvO2×10)=10×CO×(CaO2-CvO2)=CO×Hb×1.38×(SaO2-SvO2)
正常值：250ml/min(180～280ml/min)或每平方米110～130ml/min。
(三)指导心血管治疗(图)
参考文献
1 Mark JB, Skaughter TF,Reves JG. Cardiovascular monitoring. In:Miller RD. Anesthesia. 4th ed. Philadelphia:Churchill Livingstone, 1999;1117
2 孙大金，徐守春，盛卓人等，主编. 心血管麻醉和术后处理. 上海:上海科学技术文献出版社,1999;332
3 Sagemen WS. Reliability and precision of a new thoracic eletrical bioimpedance monitor in a lower body negative pressure model. Crit Care Med,1999;27(9):1986
4 Johnson KB. Influence of pulmonary edema on noninvasive measurements of cardiac output using partical CO2 rebreathing in a canine model. Anesthesiology,1998;89(3A):A535
5 王奎荣综述,陈庆廉审校. 经食管超声多谱勒心排血量测定的原理和应用. 国外医学麻醉学与复苏分册,1998;19(6):329
6 Matthay MA, Chatterjee K. Badside catheterization of the pulmonary artery: Risks compared with benefits. Ann Intern Med, 1998;109:826-834
7 Koobi-T, Kankinen-S, Ahola-T, et al. Non-invasive measurement of cardiac output:Whole-body impedance cardiography in simultaneous comparison with thermodilution and direct oxygen fick methods. Intensive-Care-Med,1997;23(11):1132-1137
8 Watt RC, Loeb RG, Orr J. Comparison of a new non-invasive cardiac output technique with invsive bolus and continuous thermodilution. Anesthesiology,1998;89:A536
9 Haryadi DG, Orr J, Dipl-lng KK, et al. Evaluation of a partial CO2 rebreathing Fick technique for measurement of cardiac output. Anesthesiology, 1998;89:A534, http://www.100md.com(杭燕南)
(一)监测心泵功能
心排血量前负荷、后负荷、心肌收缩性、每搏量和心率决定，如前负荷降低、后负荷增加，心肌收缩力减弱，则每搏量减少，如心动过速或过缓以及心律失常均可引起心排血量减少。因此，心排血量可以反映心泵功能。
(二)心血管参数计算
1、血流动力学指标正常值(表)
2、氧供需平衡指标
(1)氧供(DO2) DO2=CO×CaO2×10=CO×Hb×1.38×SaO2，正常值：1000ml/min(700～1400ml/min)或每平方米600ml/min。
(2)氧耗(VO2) VO2=(CO×CaO2×10)-(CO×CvO2×10)=10×CO×(CaO2-CvO2)=CO×Hb×1.38×(SaO2-SvO2)
正常值：250ml/min(180～280ml/min)或每平方米110～130ml/min。
(三)指导心血管治疗(图)
参考文献
1 Mark JB, Skaughter TF,Reves JG. Cardiovascular monitoring. In:Miller RD. Anesthesia. 4th ed. Philadelphia:Churchill Livingstone, 1999;1117
2 孙大金，徐守春，盛卓人等，主编. 心血管麻醉和术后处理. 上海:上海科学技术文献出版社,1999;332
3 Sagemen WS. Reliability and precision of a new thoracic eletrical bioimpedance monitor in a lower body negative pressure model. Crit Care Med,1999;27(9):1986
4 Johnson KB. Influence of pulmonary edema on noninvasive measurements of cardiac output using partical CO2 rebreathing in a canine model. Anesthesiology,1998;89(3A):A535
5 王奎荣综述,陈庆廉审校. 经食管超声多谱勒心排血量测定的原理和应用. 国外医学麻醉学与复苏分册,1998;19(6):329
6 Matthay MA, Chatterjee K. Badside catheterization of the pulmonary artery: Risks compared with benefits. Ann Intern Med, 1998;109:826-834
7 Koobi-T, Kankinen-S, Ahola-T, et al. Non-invasive measurement of cardiac output:Whole-body impedance cardiography in simultaneous comparison with thermodilution and direct oxygen fick methods. Intensive-Care-Med,1997;23(11):1132-1137
8 Watt RC, Loeb RG, Orr J. Comparison of a new non-invasive cardiac output technique with invsive bolus and continuous thermodilution. Anesthesiology,1998;89:A536
9 Haryadi DG, Orr J, Dipl-lng KK, et al. Evaluation of a partial CO2 rebreathing Fick technique for measurement of cardiac output. Anesthesiology, 1998;89:A534, http://www.100md.com(杭燕南)