周树生经胸壁心脏超声容量评估及指导快速补液试验.ppt

svi心搏量指数 被动抬腿试验可模仿快速容量负荷反应，相当于内源性容量（300～450 ｍＬ血浆）快速输入，早期曾作为休克抢救手段之一. 相关性 ΔCO50, variation of cardiac output after infusion of 50 ml of fluid over 10 seconds; ΔCO500, variation of cardiac output after infusion of 500 ml fluid over 15 minutes; ΔVTI50, variation of velocity time index after infusion of 50 ml of fluid over 10 seconds; ΔVTI500, variation of velocity time index after infusion of 500 ml of fluid over 15 minutes. ΔCO50, variation of cardiac output after infusion of 50 ml of fluid over 10 seconds. ΔCO500, variation of cardiac output after infusion of 500 ml of fluid over 15 minutes; ΔVTI50, variation of velocity time index after infusion of 50 ml of fluid over 10 seconds. ΔVTI500, variation of velocity time index after infusion of 500 ml of fluid over 15 minutes; CO, cardiac output; VTI, aortic velocity time index. 六、床旁超声预测容量反应之主动脉(AO) 在心尖五腔心断面，左心室流出道可以测量主动脉瓣的速度时间积分（VTI） 公式如下(VTImax和VTImin分别表示主动脉瓣的速度时间积分最大和最小值): ΔVTI＝（VTImax-VTImin)/[(VTImax+VTImin)/2]×100% 机械通气患者主动脉峰值血流速度呼吸变异率(Δpeak)或主动脉速度时间积分呼 吸变化率(ΔVTI)代表了容量反应性变化的幅度及前负荷。 机械通气患者主动脉峰值血流速度呼吸变异率(Δpeak)能够预测容量反应 Pediatr Cardiol. 2010 Nov;31(8):1166-70. 主动脉峰值血流速度呼吸变异率(Δpeak)预测容量反应 Chest.2001 Mar;119(3):867-73. Δpeak预测机械通气脓毒症患者容量反应 The best cut-off for ?Vpeak ao was 12%, with sensitivity, specificity,and positive and negative predictive values of 81.2%, 85.7%, 93% and 66.6%. ?PS=respiratory variations in systolic arterial pressure(SPV); ?PP=respiratory variations in pulse pressure(PPV) Chest.2001 Mar;119(3):867-73. Δpeak预测机械通气脓毒症患者容量反应 Δpeak ?PS=respiratory variations in systolic arterial pressure(SPV); ?PP=respiratory variations in pulse pressure(PPV) ?PP ?PS Pulsed Doppler before VE accurately predict the effects of VE, ?PS and ?PP are of little value in ventilated children A 10-second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness 研究方法： 前瞻性研究，55例机械通气患者。 10秒以上输液晶体溶液50毫升，另外450毫升15分钟输注。 心输出量（CO），每搏量（SV），主动脉速度时间指数（VTI），与左室射血分数（LVEF）被记录。 评估内容：特征曲线下面积（AUC）：ΔCo5