CVP的意义.ppt

CVP的意义 湘雅三医院ICU 王仟陆 1.压力指标和容量指标不具预测液体反应性，补液试验、CVP50%预测性 2.每个病人不同疾病状态甚至同一病人不同时期的心功能曲线在变化，所要求的最佳前负荷和CVP不一样，需要医生摸索观察。故也不同要求通过压力指标和容量指标来预测容量反应。 3.有液体反应性不一定需要补液，没有正常的CO，主要落脚点是满足了组织灌注没有。同时过度的补充液体会导致液体过负荷和水肿尤其是脓毒症毛细血管渗漏明显 4.何时强心（平台期） 1.压力指标和容量指标不具预测液体反应性，补液试验、CVP50%预测性 2.每个病人不同疾病状态甚至同一病人不同时期的心功能曲线在变化，所要求的最佳前负荷和CVP不一样，需要医生摸索观察。故也不同要求通过压力指标和容量指标来预测容量反应。 3.有液体反应性不一定需要补液，没有正常的CO，主要落脚点是满足了组织灌注没有。同时过度的补充液体会导致液体过负荷和水肿尤其是脓毒症毛细血管渗漏明显 4.何时强心（平台期） Crit Care Med. 1990 Jul;18(7):728-33. Postoperative fluid overload: not a benign problem. Lowell JA, Schifferdecker C, Driscoll DF, Benotti PN, Bistrian BR. Source Nutrition Support Service, New England Deaconess Hospital, Harvard Medical School, Boston, MA 02215. Abstract The incidence and consequences of fluid overload in the surgical ICU (SICU) have not been well defined, but may influence length of stay, days requiring mechanical ventilation, and mortality. Forty-eight consecutive patients admitted to our SICU were prospectively monitored for acute changes in weight and its impact on clinical management and outcome. When defined as a gain greater than 10% from their preoperative or premorbid weight (or an approximately 20% increase in total body water), 40% of patients had fluid overload. Patients were divided into three groups: those who had gained less than or equal to 10%, those with a weight gain between 11% and 20%, and those with greater than 20% increase in weight. Significant differences were found with respect to vasopressor dependence, colloid administration, and mortality. When indexed by initial Acute Physiology and Chronic Health Evaluation (APACHE II) mortality prediction scores, all groups had similar degrees of illness. On average, presumably due to volume limitations, patients were inadequately nourished during 85% of their SICU stay. Our results suggest that the morbidity of fluid overload can be significant, and warrants a fresh look at the methods of intraoperative fluid resuscitation. 1.压力指标和容量指标不具预测液体反应性，补液试验、CV