重症單位血液動力學監測介紹

Introduction of Hemodynamic Monitoring in Critical Care Units

林珍瑋(Chen-Wei Lin) ； 王筱珮(Shiao-Pei Wang)

《護理雜誌》 63卷1期 (2016/02) Pp. 117-124

https://doi.org/10.6224/JN.63.1.117

摘要

血液動力學監測是加護單位非常重要的治療活動，臨床上使用的測量方式包括肺動脈導管（pulmonary artery catheter, PAC）、心肺容積監測（pulse-induced contour cardiac output, PiCCO）及非侵入性血液動力學監測（non-invasivehemodynamic monitoring）。PAC主要是利用溫度稀釋法的原理，測量各種心肺參數，可鑑別肺動脈高壓；PiCCO是利用經肺溫度稀釋法及脈搏曲線分析法測量心肺參數，其特色是能測量出肺血管外的水容量，以預測肺水腫的發生，鑑別心源性或非心源性呼吸衰竭；非侵入性血液動力學監測則是利用胸腔電阻抗原理，測量電流通過不同排列方式的紅血球時的導電性，以計算出心搏量及其他心肺參數。加護單位的護理人員應熟練各種血液動力學監測的方式，在測量前準備好儀器設備，向病人及家屬解釋；導管放置過程中能遵守無菌技術，避免合併症發生；導管置放後，護理人員測得各項數據後應能做正確的判讀，以提供治療選擇與照護時之參考。

關鍵字

血液動力學監測 ； 肺動脈導管 ； 心肺容積監測 ； 非侵入性血液動力學監測

並列摘要

Hemodynamic monitoring is a very important treatment in intensive care units. Measurements taken during monitoring include pulmonary artery catheter (PAC), pulse-induced contour output (PiCCO), and non-invasive hemodynamic monitoring. PAC measures cardiopulmonary parameters using the thermodilution principle. PiCCO uses transpulmonary thermodilution and pulse contour analysis to measure cardiopulmonary parameters and extra-vascular lung water, to predict lung edema, and to differentiate between cardiogenic and non-cardiogenic respiratory failure. Non-invasive hemodynamic monitoring uses the thoracic electrical bioimpedance principle to measure electrical conductivity and then calculates stroke volume and cardiopulmonary parameters using the arrangement of red blood cells. The author is a nurse in an intensive care unit who is familiar with the various methods used in hemodynamic monitoring, with preparing the related devices, with briefing patients and family members prior to procedures, with related aseptic skills, with preventing complications during the insertion procedure, and with analyzing and interpreting those parameters accurately. The issues addressed in this paper are provided as a reference for nurses and other medical personnel to choose appropriate treatments when caring for critical patients.

並列關鍵字

hemodynamic monitoring ； pulmonary artery catheter ； pulse-induced contour cardiac output ； non-invasive hemodynamic monitoring

參考文獻

陳雅惠、蔡素珍（2010）．心肺容積監視器於敗血性休克病人的臨床應用．長庚護理，21（4），442–450。[Chen, Y. H., & Tsai, S. J. (2010). The clinical application of pulse-induced contour cardiac output (PiCCO) in septic shock patients. Chang Gung Nursing, 21(4), 442–450.]

盧淑芬、陳季涵、尚婉明、周幸生（2012）．重症病人導管相關血流感染的預防與照護．護理雜誌，59（4），5–11。[Lu, S. F., Chen, J. H., Shang, W. M., & Chou, S. S. (2012). Prevention and nursing care of central line-associated bloodstream infections in critically ill patients. The Journal of Nursing, 59(4), 5–11.] doi:10.6224/JN.59.4.5

Alhashemi, J. A., Cecconi, M., & Hofer, C. K. (2011). Cardiac output monitoring: An integrative perspective. Critical Care, 15(2), 214–223. doi:10.1186/cc9996

Blohm, M. E., Obrecht, D., Hartwich, J., Mueller, G. C., Kersten, J. F., Weil, J., & Singer, D. (2014). Impedance cardiography (electrical velocimetry) and transthoracic echocardiography for non-invasive cardiac output monitoring in pediatric intensive care patients: A prospective single-center observational study. Critical Care, 18(6), 603–612. doi:10.1186/s13054-014-0603-0

Chatterjee, K. (2009). The Swan-Ganz catheters: Past, present, and future. A viewpoint. Circulation, 119(1), 147–152. doi:10.1161/CIRCULATIONAHA.108.811141