\u6c27\u4f9b\u6c27\u8017\u5e73\u8861\u662f\u91cd\u75c7\u60a3\u8005\u7ba1\u7406\u4e2d\u7684\u5173\u952e\u95ee\u9898\uff0c\u5173\u7cfb\u5230\u5668\u5b98\u529f\u80fd\u548c\u751f\u5b58\u9884\u540e\u3002\u5982\u679c\u6c27\u4f9b\u4e0d\u80fd\u6ee1\u8db3\u7ec4\u7ec7\u6c27\u8017\u7684\u9700\u6c42\uff0c\u53ef\u80fd\u5bfc\u81f4\u5668\u5b98\u7f3a\u6c27\u548c\u591a\u5668\u5b98\u529f\u80fd\u969c\u788d\u3002\u7406\u89e3\u5e76\u7ba1\u7406\u6c27\u4f9b\u6c27\u8017\u5e73\u8861\uff0c\u5bf9\u4e8e\u63d0\u9ad8\u91cd\u75c7\u60a3\u8005\u7684\u6cbb\u7597\u6548\u679c\u81f3\u5173\u91cd\u8981\u3002\u672c\u6587\u5c06\u4ece\u6c27\u4f9b\u548c\u6c27\u8017\u7684\u57fa\u7840\u6982\u5ff5\u3001\u8bc4\u4f30\u65b9\u6cd5\u3001\u5e38\u89c1\u7684\u5e72\u9884\u7b56\u7565\u53ca\u5178\u578b\u75c5\u4f8b\u5206\u6790\u7b49\u65b9\u9762\u8fdb\u884c\u8be6\u7ec6\u8bb2\u89e3\u3002\u4e00\u3001\u6c27\u4f9b\uff08DO2\uff09\u7684\u57fa\u7840\u6982\u5ff51. \u6c27\u4f9b\u7684\u5b9a\u4e49\u4e0e\u516c\u5f0f\u6c27\u4f9b\uff08DO2\uff09\u662f\u6307\u901a\u8fc7\u8840\u6db2\u8fd0\u8f93\u5230\u7ec4\u7ec7\u7684\u6c27\u6c14\u91cf\uff0c\u901a\u5e38\u4f7f\u7528\u4ee5\u4e0b\u516c\u5f0f\u8ba1\u7b97\uff1aDO2=CO\u00d7CaO2\u00d710DO2 = CO \\times CaO2 \\times 10DO2=CO\u00d7CaO2\u00d710\u5176\u4e2d\uff1aCO\uff08\u5fc3\u6392\u8840\u91cf\uff09\uff1a\u6bcf\u5206\u949f\u7531\u5fc3\u810f\u8f93\u51fa\u7684\u8840\u6db2\u91cf\uff0c\u5355\u4f4d\u4e3a L\/min\u3002CaO2\uff08\u52a8\u8109\u8840\u6c27\u542b\u91cf\uff09\uff1a\u6bcf\u5347\u52a8\u8109\u8840\u6db2\u4e2d\u542b\u6709\u7684\u6c27\u6c14\u91cf\uff0c\u5355\u4f4d\u4e3a mL O2\/L \u8840\u6db2\u30022. \u52a8\u8109\u6c27\u542b\u91cf\uff08CaO2\uff09\u516c\u5f0f\u52a8\u8109\u8840\u6c27\u542b\u91cf\uff08CaO2\uff09\u7684\u8ba1\u7b97\u516c\u5f0f\u4e3a\uff1aCaO2=(1.34\u00d7Hb\u00d7SaO2)+(0.003\u00d7PaO2)CaO2 = (1.34 \\times Hb \\times SaO2) + (0.003 \\times PaO2)CaO2=(1.34\u00d7Hb\u00d7SaO2)+(0.003\u00d7PaO2)\u5176\u4e2d\uff1aHb\uff1a\u8840\u7ea2\u86cb\u767d\u6d53\u5ea6\uff0c\u5355\u4f4d\u4e3a g\/dL\u3002SaO2\uff1a\u52a8\u8109\u8840\u6c27\u9971\u548c\u5ea6\uff0c\u901a\u5e38\u901a\u8fc7\u8109\u640f\u8840\u6c27\u4eea\u6d4b\u5f97\uff0c\u5355\u4f4d\u4e3a\u767e\u5206\u6bd4\u3002PaO2\uff1a\u52a8\u8109\u8840\u6c27\u5206\u538b\uff0c\u5355\u4f4d\u4e3a mmHg\u30021.34\uff1a\u8840\u7ea2\u86cb\u767d\u7ed3\u5408\u6c27\u6c14\u7684\u7cfb\u6570\uff0c\u53731\u514b\u8840\u7ea2\u86cb\u767d\u7ed3\u54081.34 mL\u6c27\u6c14\u30023. \u51b3\u5b9a\u6c27\u4f9b\u7684\u56e0\u7d20\u5fc3\u6392\u8840\u91cf\uff08CO\uff09\uff1a\u7531\u5fc3\u7387\u548c\u6bcf\u640f\u91cf\u51b3\u5b9a\uff0c\u53d7\u8840\u5bb9\u91cf\u3001\u5fc3\u810f\u529f\u80fd\u548c\u8840\u7ba1\u963b\u529b\u7684\u5f71\u54cd\u3002\u4f4e\u8840\u5bb9\u91cf\u3001\u5fc3\u529f\u80fd\u4e0d\u5168\u548c\u5fc3\u5f8b\u5931\u5e38\u5747\u4f1a\u5f71\u54cd\u5fc3\u6392\u91cf\uff0c\u5bfc\u81f4\u6c27\u4f9b\u51cf\u5c11\u3002\u52a8\u8109\u8840\u6c27\u542b\u91cf\uff08CaO2\uff09\uff1a\u4e3b\u8981\u53d6\u51b3\u4e8e\u8840\u7ea2\u86cb\u767d\u6d53\u5ea6\u3001\u52a8\u8109\u8840\u6c27\u5206\u538b\uff08PaO2\uff09\u53ca\u6c27\u9971\u548c\u5ea6\uff08SaO2\uff09\u3002\u8d2b\u8840\u3001\u4f4e\u6c27\u8840\u75c7\u7b49\u4f1a\u964d\u4f4eCaO2\uff0c\u8fdb\u800c\u51cf\u5c11\u6c27\u4f9b\u30024. \u6c27\u4f9b\u7684\u4e34\u5e8a\u610f\u4e49\u91cd\u75c7\u60a3\u8005\u5e38\u56e0\u4f4e\u8840\u5bb9\u91cf\u3001\u4f4e\u6c27\u8840\u75c7\u6216\u5fc3\u529f\u80fd\u8870\u7aed\u7b49\u539f\u56e0\u5bfc\u81f4\u6c27\u4f9b\u4e0d\u8db3\u3002\u5982\u679c\u6c27\u4f9b\u65e0\u6cd5\u6ee1\u8db3\u4ee3\u8c22\u9700\u6c42\uff0c\u7ec4\u7ec7\u4f1a\u51fa\u73b0\u7f3a\u6c27\uff0c\u589e\u52a0\u5668\u5b98\u529f\u80fd\u969c\u788d\u548c\u6b7b\u4ea1\u7684\u98ce\u9669\u3002\u4e8c\u3001\u6c27\u8017\uff08VO2\uff09\u7684\u57fa\u7840\u6982\u5ff51. \u6c27\u8017\u7684\u5b9a\u4e49\u4e0e\u516c\u5f0f\u6c27\u8017\uff08VO2\uff09\u662f\u6307\u7ec4\u7ec7\u5b9e\u9645\u6d88\u8017\u7684\u6c27\u6c14\u91cf\uff0c\u901a\u5e38\u901a\u8fc7Fick\u516c\u5f0f\u8ba1\u7b97\uff1aVO2=CO\u00d7(CaO2\u2212CvO2)\u00d710VO2 = CO \\times (CaO2 – CvO2) \\times 10VO2=CO\u00d7(CaO2\u2212CvO2)\u00d710\u5176\u4e2d\uff1aCvO2\uff1a\u9759\u8109\u8840\u6c27\u542b\u91cf\uff0c\u53cd\u6620\u7ec4\u7ec7\u6c27\u63d0\u53d6\u7387\u30022. \u51b3\u5b9a\u6c27\u8017\u7684\u56e0\u7d20\u4ee3\u8c22\u9700\u6c42\uff1a\u673a\u4f53\u4ee3\u8c22\u7387\u76f4\u63a5\u5f71\u54cd\u6c27\u8017\u3002\u5e94\u6fc0\u72b6\u6001\u3001\u611f\u67d3\u3001\u521b\u4f24\u548c\u53d1\u70ed\u7b49\u5747\u4f1a\u663e\u8457\u589e\u52a0\u6c27\u8017\u3002\u6c27\u63d0\u53d6\u7387\uff1a\u7531\u5fae\u5faa\u73af\u704c\u6ce8\u548c\u7ebf\u7c92\u4f53\u529f\u80fd\u7b49\u56e0\u7d20\u51b3\u5b9a\u3002\u5f53\u5fae\u5faa\u73af\u969c\u788d\u6216\u7ebf\u7c92\u4f53\u529f\u80fd\u4e0d\u5168\u65f6\uff0c\u5373\u4f7f\u6c27\u4f9b\u5145\u8db3\uff0c\u6c27\u8017\u4e5f\u4f1a\u4e0b\u964d\u30023. \u6c27\u8017\u7684\u4e34\u5e8a\u610f\u4e49\u6c27\u8017\u589e\u52a0\u7684\u60c5\u51b5\u5e38\u89c1\u4e8e\u5168\u8eab\u708e\u75c7\u53cd\u5e94\u3001\u611f\u67d3\u3001\u624b\u672f\u521b\u4f24\u7b49\u3002\u5f53\u6c27\u4f9b\u65e0\u6cd5\u6ee1\u8db3\u6c27\u8017\u9700\u6c42\u65f6\uff0c\u7ec4\u7ec7\u4ee3\u8c22\u4ece\u6709\u6c27\u8f6c\u4e3a\u65e0\u6c27\uff0c\u5bfc\u81f4\u4e73\u9178\u751f\u6210\u589e\u52a0\u3002\u6301\u7eed\u7684\u9ad8\u6c27\u8017\u4e0e\u4f4e\u6c27\u4f9b\u53ef\u80fd\u5bfc\u81f4\u5668\u5b98\u529f\u80fd\u969c\u788d\u3002\u4e09\u3001\u6c27\u4f9b\u6c27\u8017\u4e0d\u5e73\u8861\u7684\u8bc4\u4f30\u65b9\u6cd51. \u9759\u8109\u8840\u6c27\u9971\u548c\u5ea6\uff08SvO2\uff09SvO2 \u662f\u8bc4\u4f30\u6c27\u4f9b\u6c27\u8017\u5e73\u8861\u7684\u4e3b\u8981\u6307\u6807\u4e4b\u4e00\u3002\u6b63\u5e38\u60c5\u51b5\u4e0b\uff0cSvO2 \u4e3a 60-80%\u3002SvO2 \u964d\u4f4e\u63d0\u793a\u6c27\u4f9b\u4e0d\u8db3\u6216\u6c27\u8017\u8fc7\u9ad8\uff0c\u673a\u4f53\u6b63\u5728\u901a\u8fc7\u589e\u52a0\u6c27\u63d0\u53d6\u7387\u6765\u5e94\u5bf9\u6c27\u4f9b\u51cf\u5c11\u3002\u5f53SvO2\u6301\u7eed\u4e0b\u964d\u4e14\u4f34\u968f\u5176\u4ed6\u7f3a\u6c27\u8ff9\u8c61\u65f6\uff0c\u5e94\u7acb\u5373\u5e72\u9884\u30022. \u4e73\u9178\u6c34\u5e73\u4e73\u9178\u662f\u65e0\u6c27\u4ee3\u8c22\u7684\u4ea7\u7269\uff0c\u8840\u4e73\u9178\u6c34\u5e73\u5347\u9ad8\u63d0\u793a\u7ec4\u7ec7\u7f3a\u6c27\u548c\u4ee3\u8c22\u7d0a\u4e71\u3002\u4e73\u9178\u6c34\u5e73\u5927\u4e8e2 mmol\/L\u901a\u5e38\u63d0\u793a\u6c27\u4f9b\u4e0d\u8db3\uff0c\u7279\u522b\u662f\u5728\u4f11\u514b\u60a3\u8005\u4e2d\uff0c\u4e73\u9178\u6c34\u5e73\u662f\u9884\u540e\u8bc4\u4f30\u7684\u91cd\u8981\u6307\u6807\u30023. \u52a8\u9759\u8109 CO2 \u538b\u5dee\uff08\u0394PCO2\uff09\u0394PCO2 \u662f\u8bc4\u4f30\u7ec4\u7ec7\u704c\u6ce8\u7684\u91cd\u8981\u6307\u6807\u3002\u0394PCO2 \u6b63\u5e38\u503c\u901a\u5e38\u5c0f\u4e8e6 mmHg\u3002\u0394PCO2 \u589e\u5927\u63d0\u793a\u7ec4\u7ec7\u8840\u6d41\u704c\u6ce8\u4e0d\u8db3\uff0c\u53ef\u80fd\u4e0e\u4f4e\u6c27\u4f9b\u6216\u5fc3\u6392\u8840\u91cf\u4e0d\u8db3\u6709\u5173\u30024. \u5fc3\u6392\u8840\u91cf\u76d1\u6d4b\u5bf9\u4e8e\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u7684\u60a3\u8005\uff0c\u901a\u8fc7\u6709\u521b\u6216\u65e0\u521b\u624b\u6bb5\u76d1\u6d4b\u5fc3\u6392\u8840\u91cf\u662f\u8bc4\u4f30\u6c27\u4f9b\u7684\u6838\u5fc3\u63aa\u65bd\u3002\u5fc3\u6392\u91cf\u4e0b\u964d\u901a\u5e38\u4f34\u968f\u6c27\u4f9b\u4e0d\u8db3\uff0c\u9700\u53ca\u65f6\u8c03\u6574\u6db2\u4f53\u7ba1\u7406\u548c\u4f7f\u7528\u8840\u7ba1\u6d3b\u6027\u836f\u7269\u3002\u56db\u3001\u4f18\u5316\u6c27\u4f9b\u7684\u65b9\u6cd51. \u63d0\u9ad8\u6c27\u5408\u6c34\u5e73\u6c27\u7597\uff1a\u5bf9\u4e8e\u4f4e\u6c27\u8840\u75c7\u60a3\u8005\uff0c\u5e94\u7acb\u5373\u7ed9\u4e88\u6c27\u7597\uff0c\u7ef4\u6301PaO2\u5728\u76ee\u6807\u8303\u56f4\u5185\uff08\u901a\u5e38\u4e3a60-100 mmHg\uff09\uff0c\u6216\u4f7f\u7528\u673a\u68b0\u901a\u6c14\u652f\u6301\u4ee5\u63d0\u9ad8SaO2\u3002\u673a\u68b0\u901a\u6c14\uff1a\u5bf9\u4e8e\u6c27\u5408\u4e25\u91cd\u969c\u788d\u7684\u60a3\u8005\uff0c\u673a\u68b0\u901a\u6c14\u53ef\u6539\u5584\u6c27\u5408\uff0c\u5e76\u964d\u4f4e\u547c\u5438\u4f5c\u529f\u30022. \u589e\u52a0\u5fc3\u6392\u8840\u91cf\u6db2\u4f53\u590d\u82cf\uff1a\u5bf9\u4e8e\u8840\u5bb9\u91cf\u4e0d\u8db3\u7684\u60a3\u8005\uff0c\u8865\u5145\u6db2\u4f53\u662f\u63d0\u9ad8\u5fc3\u6392\u8840\u91cf\u7684\u57fa\u7840\u63aa\u65bd\u3002\u6db2\u4f53\u590d\u82cf\u7684\u76ee\u6807\u662f\u4f18\u5316\u524d\u8d1f\u8377\u3001\u63d0\u9ad8\u5fc3\u8f93\u51fa\u91cf\uff0c\u540c\u65f6\u907f\u514d\u6db2\u4f53\u8fc7\u591a\u5f15\u53d1\u7684\u5fc3\u810f\u8d1f\u8377\u8fc7\u91cd\u3002\u8840\u7ba1\u6d3b\u6027\u836f\u7269\uff1a\u5bf9\u4e8e\u8840\u7ba1\u963b\u529b\u4f4e\u3001\u8840\u538b\u4f4e\u7684\u60a3\u8005\uff0c\u53ef\u4f7f\u7528\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u7b49\u836f\u7269\u589e\u52a0\u8840\u7ba1\u963b\u529b\u548c\u8840\u538b\uff0c\u4ece\u800c\u63d0\u9ad8\u5fc3\u6392\u8840\u91cf\u3002\u6b63\u6027\u808c\u529b\u836f\u7269\uff1a\u5982\u591a\u5df4\u915a\u4e01\u80fa\uff08Dobutamine\uff09\uff0c\u9002\u7528\u4e8e\u5fc3\u810f\u6536\u7f29\u529b\u51cf\u5f31\u7684\u60a3\u8005\uff0c\u901a\u8fc7\u589e\u5f3a\u5fc3\u808c\u6536\u7f29\u529b\u589e\u52a0\u5fc3\u6392\u8840\u91cf\u30023. \u7ea0\u6b63\u8d2b\u8840\u8f93\u8840\uff1a\u5bf9\u4e8e\u8840\u7ea2\u86cb\u767d\u660e\u663e\u964d\u4f4e\u7684\u60a3\u8005\uff0c\u8f93\u6ce8\u7ea2\u7ec6\u80de\u53ef\u6709\u6548\u63d0\u9ad8CaO2\uff0c\u8fdb\u800c\u589e\u52a0\u6c27\u4f9b\u3002\u901a\u5e38\uff0c\u5f53Hb\u4f4e\u4e8e7-8 g\/dL\u65f6\uff0c\u5e94\u8003\u8651\u8f93\u8840\u5e72\u9884\u3002\u4e94\u3001\u964d\u4f4e\u6c27\u8017\u7684\u65b9\u6cd51. \u63a7\u5236\u4ee3\u8c22\u9700\u6c42\u9547\u9759\u548c\u9547\u75db\uff1a\u6709\u6548\u7684\u9547\u9759\u548c\u9547\u75db\u80fd\u51cf\u5c11\u5e94\u6fc0\u53cd\u5e94\u3001\u964d\u4f4e\u4ee3\u8c22\u9700\u6c42\uff0c\u51cf\u5c11\u6c27\u8017\u3002\u7279\u522b\u662f\u5bf9\u4e8e\u673a\u68b0\u901a\u6c14\u60a3\u8005\uff0c\u9547\u9759\u6709\u52a9\u4e8e\u964d\u4f4e\u547c\u5438\u4f5c\u529f\u3002\u4f53\u6e29\u7ba1\u7406\uff1a\u53d1\u70ed\u4f1a\u663e\u8457\u589e\u52a0\u4ee3\u8c22\u7387\u548c\u6c27\u8017\u3002\u5bf9\u4e8e\u9ad8\u70ed\u60a3\u8005\uff0c\u9002\u5f53\u7684\u9000\u70ed\u63aa\u65bd\uff08\u5982\u7269\u7406\u964d\u6e29\u3001\u836f\u7269\u964d\u6e29\uff09\u80fd\u6709\u6548\u964d\u4f4e\u6c27\u8017\u30022. \u65e9\u671f\u6297\u611f\u67d3\u6cbb\u7597\u611f\u67d3\u5f15\u53d1\u7684\u5168\u8eab\u708e\u75c7\u53cd\u5e94\u7efc\u5408\u5f81\uff08SIRS\uff09\u4f1a\u663e\u8457\u589e\u52a0\u6c27\u8017\u3002\u65e9\u671f\u4f7f\u7528\u5408\u9002\u7684\u6297\u751f\u7d20\u548c\u6297\u611f\u67d3\u6cbb\u7597\u53ef\u4ee5\u6709\u6548\u63a7\u5236\u611f\u67d3\uff0c\u964d\u4f4e\u5168\u8eab\u4ee3\u8c22\u7387\uff0c\u8fdb\u800c\u51cf\u5c11\u6c27\u8017\u30023. \u63a7\u5236\u547c\u5438\u4f5c\u529f\u5bf9\u4e8e\u547c\u5438\u7a98\u8feb\u7684\u60a3\u8005\uff0c\u7279\u522b\u662f\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\uff08ARDS\uff09\u60a3\u8005\uff0c\u547c\u5438\u4f5c\u529f\u663e\u8457\u589e\u52a0\u3002\u901a\u8fc7\u673a\u68b0\u901a\u6c14\u51cf\u5c11\u60a3\u8005\u7684\u547c\u5438\u4f5c\u529f\uff0c\u6709\u52a9\u4e8e\u964d\u4f4e\u6c27\u8017\u3002\u75c5\u4f8b\u80cc\u666f\u60a3\u8005\u7537\u6027\uff0c68\u5c81\uff0c\u56e0\u53d1\u70ed\u3001\u54b3\u55fd\u3001\u6c14\u4fc3\u52a0\u91cd3\u5929\u5165\u4f4fICU\u3002\u521d\u6b65\u8bca\u65ad\u4e3a\u91cd\u75c7\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e\uff08CAP\uff09\uff0c\u5e76\u53d1\u611f\u67d3\u6027\u4f11\u514b\u3002\u5165\u9662\u65f6\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\uff0c\u547c\u5438\u7a98\u8feb\uff0c\u4f7f\u7528\u673a\u68b0\u901a\u6c14\u652f\u6301\u3002\u521d\u59cb\u8bc4\u4f30\uff1a\u52a8\u8109\u6c27\u9971\u548c\u5ea6\uff08SaO2\uff09\uff1a90%\u52a8\u8109\u8840\u6c27\u5206\u538b\uff08PaO2\uff09\uff1a65 mmHg\uff08FiO2 0.6\uff0cPEEP 5 cmH2O\uff09\u9759\u8109\u8840\u6c27\u9971\u548c\u5ea6\uff08SvO2\uff09\uff1a55%\u4e73\u9178\u6c34\u5e73\uff1a5.2 mmol\/L\u8840\u7ea2\u86cb\u767d\uff08Hb\uff09\uff1a9.5 g\/dL\u5fc3\u6392\u8840\u91cf\uff08CO\uff09\uff1a4.0 L\/min\u4e2d\u592e\u9759\u8109\u538b\uff08CVP\uff09\uff1a7 mmHg\u6c27\u4f9b\u6c27\u8017\u8bc4\u4f30\u6c27\u4f9b\u8bc4\u4f30\uff08DO2\uff09\uff1a\u4f7f\u7528\u516c\u5f0f DO2=CO\u00d7CaO2\u00d710DO2 = CO \\times CaO2 \\times 10DO2=CO\u00d7CaO2\u00d710\u52a8\u8109\u6c27\u542b\u91cf\uff08CaO2\uff09\u8ba1\u7b97\uff1aCaO2=(1.34\u00d7Hb\u00d7SaO2)+(0.003\u00d7PaO2)CaO2 = (1.34 \\times Hb \\times SaO2) + (0.003 \\times PaO2)CaO2=(1.34\u00d7Hb\u00d7SaO2)+(0.003\u00d7PaO2)CaO2=(1.34\u00d79.5\u00d70.90)+(0.003\u00d765)CaO2 = (1.34 \\times 9.5 \\times 0.90) + (0.003 \\times 65)CaO2=(1.34\u00d79.5\u00d70.90)+(0.003\u00d765)CaO2\u224811.5mLO2\/dLCaO2 \\approx 11.5 mL O2\/dLCaO2\u224811.5mLO2\/dL\u6c27\u4f9b\uff08DO2\uff09\u8ba1\u7b97\uff1aDO2=4.0\u00d711.5\u00d710=460mLO2\/minDO2 = 4.0 \\times 11.5 \\times 10 = 460 mL O2\/minDO2=4.0\u00d711.5\u00d710=460mLO2\/min\u7ed3\u679c\u89e3\u8bfb\uff1a\u60a3\u8005\u7684\u6c27\u4f9b\u4f4e\u4e8e\u6b63\u5e38\u53c2\u8003\u8303\u56f4\uff08600-800 mL\/min\uff09\uff0c\u63d0\u793a\u6c27\u4f9b\u4e0d\u8db3\u3002\u6c27\u8017\u8bc4\u4f30\uff08VO2\uff09\uff1a\u4f7f\u7528Fick\u516c\u5f0f\u8ba1\u7b97\u6c27\u8017 VO2=CO\u00d7(CaO2\u2212CvO2)\u00d710VO2 = CO \\times (CaO2 – CvO2) \\times 10VO2=CO\u00d7(CaO2\u2212CvO2)\u00d710\u9759\u8109\u6c27\u542b\u91cf\uff08CvO2\uff09\uff1aCvO2=(1.34\u00d7Hb\u00d7SvO2)+(0.003\u00d7PvO2)CvO2 = (1.34 \\times Hb \\times SvO2) + (0.003 \\times PvO2)CvO2=(1.34\u00d7Hb\u00d7SvO2)+(0.003\u00d7PvO2)CvO2=(1.34\u00d79.5\u00d70.55)CvO2 = (1.34 \\times 9.5 \\times 0.55)CvO2=(1.34\u00d79.5\u00d70.55)CvO2\u22487.0mLO2\/dLCvO2 \\approx 7.0 mL O2\/dLCvO2\u22487.0mLO2\/dL\u6c27\u8017\uff08VO2\uff09\u8ba1\u7b97\uff1aVO2=4.0\u00d7(11.5\u22127.0)\u00d710=180mLO2\/minVO2 = 4.0 \\times (11.5 – 7.0) \\times 10 = 180 mL O2\/minVO2=4.0\u00d7(11.5\u22127.0)\u00d710=180mLO2\/min\u7ed3\u679c\u89e3\u8bfb\uff1a\u60a3\u8005\u6c27\u8017\u5347\u9ad8\uff0c\u53ef\u80fd\u662f\u7531\u4e8e\u611f\u67d3\u6027\u4f11\u514b\u548c\u5e94\u6fc0\u72b6\u6001\u5f15\u8d77\u7684\u4ee3\u8c22\u589e\u52a0\u3002\u6c27\u4f9b\u6c27\u8017\u5e73\u8861\u8bc4\u4f30\uff1aSvO2\u4e3a55%\uff0c\u660e\u663e\u4f4e\u4e8e\u6b63\u5e38\u503c\uff0860-80%\uff09\uff0c\u63d0\u793a\u60a3\u8005\u7684\u6c27\u4f9b\u4e0d\u80fd\u6ee1\u8db3\u7ec4\u7ec7\u6c27\u8017\u9700\u6c42\uff0c\u5b58\u5728\u6c27\u4f9b\u6c27\u8017\u4e0d\u5e73\u8861\u3002\u4e73\u9178\u6c34\u5e73\u663e\u8457\u5347\u9ad8\uff08>2 mmol\/L\uff09\uff0c\u8fdb\u4e00\u6b65\u63d0\u793a\u7ec4\u7ec7\u7f3a\u6c27\uff0c\u6c27\u4f9b\u4e0d\u8db3\u4ee5\u652f\u6301\u6709\u6c27\u4ee3\u8c22\u3002\u5904\u7406\u7b56\u7565\u4f18\u5316\u6c27\u4f9b\uff1a\u60a3\u8005\u8840\u7ea2\u86cb\u767d\u6c34\u5e739.5 g\/dL\uff0c\u8003\u8651\u6839\u636e\u6c27\u4f9b\u9700\u6c42\u8f93\u8840\uff0c\u76ee\u6807Hb >10 g\/dL\uff0c\u4ee5\u63d0\u9ad8CaO2\u3002\u589e\u52a0FiO2\u81f30.8\uff0c\u9002\u5f53\u63d0\u9ad8PEEP\u81f38 cmH2O\uff0c\u6539\u5584\u80ba\u6ce1\u901a\u6c14\uff0c\u589e\u52a0\u52a8\u8109\u8840\u6c27\u542b\u91cf\uff08CaO2\uff09\u3002\u7531\u4e8eCVP 7 mmHg\uff0c\u63d0\u793a\u8840\u5bb9\u91cf\u4e0d\u8db3\uff0c\u8003\u8651\u8865\u6db2\u590d\u82cf\uff0c\u76ee\u6807CVP 8-12 mmHg\u3002\u7ee7\u7eed\u52a8\u6001\u8bc4\u4f30\u6db2\u4f53\u53cd\u5e94\u6027\uff0c\u5e94\u7528\u6b63\u6027\u808c\u529b\u836f\u7269\uff08\u5982\u591a\u5df4\u915a\u4e01\u80fa\uff09\u4ee5\u589e\u5f3a\u5fc3\u808c\u6536\u7f29\u529b\uff0c\u63d0\u9ad8\u5fc3\u6392\u8840\u91cf\u3002\u589e\u52a0\u5fc3\u6392\u8840\u91cf\uff1a\u63d0\u9ad8\u6c27\u5408\uff1a\u7ea0\u6b63\u8d2b\u8840\uff1a\u964d\u4f4e\u6c27\u8017\uff1a\u9547\u9759\uff1a\u4f7f\u7528\u9547\u9759\u836f\u7269\uff08\u5982\u4e19\u6cca\u915a\u6216\u54aa\u8fbe\u5511\u4ed1\uff09\u964d\u4f4e\u5e94\u6fc0\u53cd\u5e94\u548c\u4ee3\u8c22\u9700\u6c42\uff0c\u51cf\u5c11\u6c27\u8017\u3002\u63a7\u5236\u611f\u67d3\uff1a\u65e9\u671f\u6297\u751f\u7d20\u6cbb\u7597\uff0c\u63a7\u5236\u611f\u67d3\u6e90\uff0c\u964d\u4f4e\u5168\u8eab\u708e\u75c7\u53cd\u5e94\u548c\u4ee3\u8c22\u7387\u3002\u4f53\u6e29\u7ba1\u7406\uff1a\u5982\u679c\u60a3\u8005\u53d1\u70ed\uff0c\u9002\u5f53\u4f7f\u7528\u7269\u7406\u964d\u6e29\u6216\u836f\u7269\u9000\u70ed\uff0c\u907f\u514d\u9ad8\u6e29\u589e\u52a0\u6c27\u8017\u3002\u5904\u7406\u540e\u7684\u6c27\u4f9b\u6c27\u8017\u53d8\u5316\u7ecf\u8fc7\u4e0a\u8ff0\u5e72\u9884\u540e\uff0c24\u5c0f\u65f6\u590d\u67e5\uff1a\u52a8\u8109\u6c27\u9971\u548c\u5ea6\uff08SaO2\uff09\uff1a95%\u52a8\u8109\u8840\u6c27\u5206\u538b\uff08PaO2\uff09\uff1a85 mmHg\uff08FiO2 0.8\uff0cPEEP 8 cmH2O\uff09\u9759\u8109\u8840\u6c27\u9971\u548c\u5ea6\uff08SvO2\uff09\uff1a65%\u4e73\u9178\u6c34\u5e73\uff1a2.8 mmol\/L\u8840\u7ea2\u86cb\u767d\uff08Hb\uff09\uff1a10.2 g\/dL\u5fc3\u6392\u8840\u91cf\uff08CO\uff09\uff1a5.2 L\/min\u4e2d\u592e\u9759\u8109\u538b\uff08CVP\uff09\uff1a10 mmHg\u6c27\u4f9b\u6539\u5584\uff1a\u8840\u7ea2\u86cb\u767d\u63d0\u5347\u81f310.2 g\/dL\uff0c\u52a8\u8109\u6c27\u542b\u91cf\uff08CaO2\uff09\u589e\u52a0\u81f3\u7ea613.2 mL O2\/dL\uff0c\u5fc3\u6392\u8840\u91cf\u589e\u52a0\u81f35.2 L\/min\u3002\u6c27\u4f9b\uff08DO2\uff09\u91cd\u65b0\u8ba1\u7b97\uff1aDO2=5.2\u00d713.2\u00d710=686mLO2\/minDO2 = 5.2 \\times 13.2 \\times 10 = 686 mL O2\/minDO2=5.2\u00d713.2\u00d710=686mLO2\/min\u6c27\u4f9b\u8fbe\u5230\u6b63\u5e38\u8303\u56f4\uff0c\u8868\u660e\u5e72\u9884\u63aa\u65bd\u6709\u6548\u3002\u6c27\u8017\u6539\u5584\uff1a\u4e73\u9178\u6c34\u5e73\u4ece5.2 mmol\/L\u4e0b\u964d\u81f32.8 mmol\/L\uff0cSvO2\u4ece55%\u63d0\u5347\u81f365%\uff0c\u63d0\u793a\u7ec4\u7ec7\u6c27\u4f9b\u6539\u5584\uff0c\u4ee3\u8c22\u72b6\u6001\u9010\u6e10\u6062\u590d\u3002\u6c27\u8017\uff08VO2\uff09\u91cd\u65b0\u8ba1\u7b97\uff1aVO2=5.2\u00d7(13.2\u22128.2)\u00d710=260mLO2\/minVO2 = 5.2 \\times (13.2 – 8.2) \\times 10 = 260 mL O2\/minVO2=5.2\u00d7(13.2\u22128.2)\u00d710=260mLO2\/min\u6c27\u8017\u6709\u6240\u589e\u52a0\uff0c\u53ef\u80fd\u4e0e\u5fc3\u6392\u8840\u91cf\u548c\u4ee3\u8c22\u6062\u590d\u6709\u5173\uff0c\u4f46\u6c27\u4f9b\u6539\u5584\u540e\uff0c\u7ec4\u7ec7\u7f3a\u6c27\u72b6\u51b5\u5f97\u5230\u7f13\u89e3\u3002\u7ed3\u8bba\u901a\u8fc7\u4f18\u5316\u6c27\u4f9b\u548c\u964d\u4f4e\u6c27\u8017\uff0c\u60a3\u8005\u7684\u6c27\u4f9b\u6c27\u8017\u9010\u6e10\u6062\u590d\u5e73\u8861\uff0c\u4e73\u9178\u6c34\u5e73\u4e0b\u964d\uff0c\u8840\u6d41\u52a8\u529b\u5b66\u7a33\u5b9a\uff0c\u63d0\u793a\u6cbb\u7597\u6709\u6548\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"
\u6c27\u4f9b\u6c27\u8017\u5e73\u8861\u662f\u91cd\u75c7\u60a3\u8005\u7ba1\u7406\u4e2d\u7684\u5173\u952e\u95ee\u9898\uff0c\u5173\u7cfb\u5230\u5668\u5b98\u529f\u80fd\u548c\u751f\u5b58\u9884\u540e\u3002\u5982\u679c\u6c27\u4f9b\u4e0d\u80fd\u6ee1 … \u7ee7\u7eed\u9605\u8bfb