参考答案:E
<p><span style=";font-family:宋体;background:white">中心静脉压(</span><span style=";font-family:Arial;background:white">CVP</span><span style=";font-family:宋体;background:white">)是上、下腔静脉进入右心房处的压力,通过上、下腔静脉或右心房内置管测得,它反映右房压,是临床观察血液动力学的主要指标之一,它受心功能、循环血容量及血管张力</span><span style=";font-family:Arial;background:white">3</span><span style=";font-family:宋体;background:white">个因素影响。通常将右心房和胸腔内大静脉的血压称为中心静脉压。测定</span><span style=";font-family:Arial;background:white">CVP</span><span style=";font-family:宋体;background:white">对了解有效循环血容量和心功能有重要意义。正常值为</span><span style=";font-family:Arial;background:white">0.05</span><span style=";font-family:宋体;background:white">~</span><span style=";font-family:Arial;background:white">0.12Kpa</span><span style=";font-family:宋体;background:white">(</span><span style=";font-family:Arial;background:white">5</span><span style=";font-family:宋体;background:white">~</span><span style=";font-family:Arial;background:white">12cmH</span><sub><span style="font-size:12px;font-family:Arial;background:white">2</span></sub><span style=";font-family:Arial;background:white">O</span><span style=";font-family:宋体;background:white">)或</span><span style=";font-family:Arial;background:white">0.49</span><span style=";font-family:宋体;background:white">~</span><span style=";font-family:Arial;background:white">1.18Kpa</span><span style=";font-family:宋体;background:white">(</span><span style=";font-family:Arial;background:white">50</span><span style=";font-family:宋体;background:white">~</span><span style=";font-family:Arial;background:white">120mmH</span><sub><span style="font-size:12px;font-family:Arial;background:white">2</span></sub><span style=";font-family:Arial;background:white">O</span><span style=";font-family:宋体;background:white">)。</span></p><p><span style=";font-family:宋体"> </span><span style=";font-family:Arial;background:white">CVP</span><span style=";font-family:宋体;background:white">由四部分组成:</span><span style=";font-family:宋体;background:white">①</span><span style=";font-family: 宋体;background:white">右心室充盈压;</span><span style=";font-family:宋体;background:white">②</span><span style=";font-family:宋体;background:white">静脉内壁压;</span><span style=";font-family:宋体;background:white">③</span><span style=";font-family: 宋体;background:white">静脉收缩压和张力;</span><span style=";font-family:宋体;background:white">④</span><span style=";font-family:宋体;background:white">静脉毛细血管压。</span></p><p style="text-indent: 32px;line-height: 24px;background: white"><span style=";font-family:宋体"> </span><span style=";font-family:宋体">中心静脉压可作为临床上作为补液速度和补液量的指标。</span></p><p style="text-indent: 32px;line-height: 24px;background: white"><span style=";font-family:宋体">容量负荷试验</span><span style=";font-family:Arial">-</span><span style=";font-family:宋体">可作为对</span><span style=";font-family: Arial">CVP</span><span style=";font-family:宋体">较高,但仍有心排出量不足临床表现的病人的治疗参考。如果在</span><span style=";font-family:Arial">20</span><span style=";font-family:宋体">分钟内快速输入</span><span style=";font-family:Arial">500ml</span><span style=";font-family:宋体">液体,</span><span style=";font-family:Arial">CVP</span><span style=";font-family:宋体">升高不明显,甚至有所下降;同时血压有所上升、心率下降,即表明病人有绝对或相对的容量不足,并且心脏有继续接受大量输液的潜力;反之,输液必须慎重。</span></p><p style="text-indent: 32px;line-height: 24px;background: white"><span style=";font-family:宋体">测定</span><span style=";font-family:Arial">CVP</span><span style=";font-family:宋体">对了解有效循环血容量和心功能有重要意义。</span></p><p style="text-indent: 32px;line-height: 24px;background: white"><span style=";font-family:宋体">中心静脉压的大小取决于心脏射血能力和静脉回心血量之间的相互关系。若心脏射血能力强,能将回心的血液及时射到动脉内,中心静脉压则低。反之由于心力衰竭等原因造成的射血能力下降则会导致中心静脉压变高。中心静脉压提示静脉血回流到中心静脉和右心房的情况,但不直接反映血容量,若因为病因不能取得</span><span style=";font-family:Arial">CVP</span><span style=";font-family:宋体">,也可测膈肌下的下腔静脉代替中心静脉压,中心静脉压变化一般较动脉压变化早。</span></p><p><span style="font-size:14px;font-family:宋体">若中心静脉压小于</span><span style="font-size:14px;font-family:Arial">0.49kPa</span><span style="font-size:14px;font-family:宋体">,为右心房充盈不足或血容量不足;中心静脉压大于</span><span style="font-size:14px;font-family:Arial">1.47kPa</span><span style="font-size:14px;font-family:宋体">(</span><span style="font-size:14px;font-family:Arial">15cmH</span><sub><span style="font-size:12px;font-family:Arial">2</span></sub><span style="font-size:14px;font-family:Arial">O</span><span style="font-size:14px;font-family:宋体">)时,提示心功能不全、静脉血管床过度收缩或肺循环阻力增高;若</span><span style="font-size:14px;font-family:Arial">CVP</span><span style="font-size:14px;font-family:宋体">超过</span><span style="font-size:14px;font-family:Arial">1.96kPa</span><span style="font-size:14px;font-family:宋体">(</span><span style="font-size:14px;font-family:Arial">20cmH</span><sub><span style="font-size:12px;font-family:Arial">2</span></sub><span style="font-size:14px;font-family:Arial">O</span><span style="font-size:14px;font-family:宋体">)时,则表示存在充血性心力衰竭。</span></p>
对可疑糖尿病病人应进行OGTT确诊,本题为记忆型考题。
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