The Shark's Theory and Stool Diagram of Cardiac Output and Its Clinical Implications

心輸出量的凳子圖解及SHARK理論及其臨床應用

黃國石(K. Shark Wong) ； 謝凱生(Kai-Sheng Hsieh) ； 蘇清泉(Ching-Chyuan Su)

《重症醫學雜誌》 14卷2期 (2013/04) Pp. 61-69

摘要

心輸出量（Cardiac Output）是血流力學評估的重要指標，但其基礎知識甚為複雜。簡單而言，以下6個名詞是有著密切關係的；Cardiac Output (CO), Mean Arterial Pressure (MAP), Heart Rate (HR), Volume代表Preload (V)，Pump代表Contractility (P)，以及Systemic Vascular Resistance代表Afterload (SVR)。傳統上，心輸出量由以下公式導出：(1) The physiologic equation of CO：計算式略。另由電學的數據定律，可以流體力學公式代換成；(2) Ohm's Law (1826)：計算式略。但是，Equation (1)與MAP並無直接關聯，Equation (2)也無HR的直接證據，這樣的矛盾已長期存在。到目前為止，並無人認真的去排除它，以致Basic Hemodynamics（血流動力學）長期陷入難以捉摸的境界，許多專家們只好依據個人的嗜好，去詮釋神祕的Basic Hemodynamics了。本篇所提理論及圖解，提供一個創新的步驟去掀開Basic Hemodynamics面紗，排除長期存在的矛盾：我們利用數學的方式將Equation (1) The Physiologic equation of CO→CO=f(R,V, P, SVR)以及Equation (2) Ohm's Law CO = f(MAP, SVR)重新組合後所得之MAP=f(R, V, P)來成功的排除前所敘述之矛盾：計算式略中可找到MAP躲藏的地方了。計算式略中也找到了HR的位置。故，以上兩個方程式中都可以證明，CO, MAP, R, V, P, and SVR的密切關係。以上雖屬小小的探索，但大大的掀開了Basic Hemodynamics的面紗。進一步由本文中所推論出來的The Shark's Theory and Stool Diagram of CO將來勢必成為學習Basic Hemodynamics來龍去脈的重要捷徑。

關鍵字

心輸出量 ； 平均動脈壓 ； 心律 ； 前負荷 ； 收縮力 ； 全身血管阻力

並列摘要

It is agreed unanimously that Cardiac Output (CO), Mean Arterial Pressure (MAP), Heart Rate (HR), Volume representing Preload (V), Pump representing Contractility (P) and Systemic Vascular Resistance representing After load (SVR) are closely related. The physiologic equation of CO and Ohm's Law (1826) are also held as truth. However, questions arise as to how the physiologic equation of CO and Ohm's Law can in isolation satisfactorily explain these relationships without direct involvement of MAP, and without direct involvement of HR, respectively. These discrepancies have long existed yet nobody has, to date, endeavoured to seriously eliminate them, leaving hemodynamics obscure, sophisticated and mysterious for many decades. Even today, many authorities are still explaining hemodynamics using different and puzzling opinions. The following mathematical approach is being employed to eliminate the above discrepancies: Equation (1): The physiological equation of CO→CO=f(R, V, P, SVR) Equation (2): Ohm's law of CO→CO=f(MAP, SVR) The clear definition of MAP=f( R, V, P) is thus obtained. Therefore, the equation is abbreviated. MAP (as one of the three supports of MAP) Therefore, the close relationship of CO, MAP, R, V, P and SVR can be demonstrated in both equations. This provides a small but important step forward in unveiling the mystery of the basic hemodynamics. The Shark's Theory and Stool Diagram of CO innovatively presented in this manuscript will hopefully become a new teaching model for the clinicians to facilitate better command of this subject in the near future.

並列關鍵字

Cardiac output (CO) ； Mean arterial pressure (MAP) ； Heart rate (R) ； Preload (V) ； Contractility (P) ； Systemic vascular resistance (SVR)