PICCO临床应用教程分析.pptVIP

PICCO相关参数分类 容量/前负荷参数 胸腔内血容积ITBV 每搏量变异SVV 全心舒张末期容积GEDV脉压变异PVV 流量/后负荷参数 心输出量 CO 每搏量 SV 系统血管阻力 SVR 心肌收缩力参数 全心射血分数 GEF 心功能指数 CFI 左心室收缩力指数 dPmx 肺相关参数 血管外肺水 EVLW 肺血管通透性指数 PVPI 回到此患者 在PiCCO动态监测指导下，积极给予灵活调节血管活性药物，同时利用CRRT调整液体平衡，辅以各种预见性治疗及对症支持治疗 辅助检查 时间 GST（U/L）LDH （U/L） CK （U/L） CK-MB （U/L） 02.06 6 811 204 4 02.07 210 2191 808 78 02.09 479 2916 249 13 02.11 221 1559 424 14 02.12 93 1506 455 3 02.13 76 1133 233 18 辅助检查 2012.02.09 心脏彩超示：EF：71% 三尖瓣轻度返流。 2012.02.10 胸片示：1.左肺上野条索状、右下肺野内带斑片状高密度影；2.双肺门影稍增大；3.心影增大。 2012.02.11 肌钙蛋白T：阳性 BNP：289pg/ml 20天后患者顺利度过心肌损伤危险期，心衰得到纠正，各脏器功能平稳恢复，最终康复出院。 小结 血流动力学监测可改变临床决策----山穷水尽 柳暗花明----PiCCO 操作简便 持续监测 容量/前负荷参数 流量/后负荷参数 心肌收缩力参数 肺相关参数 谢谢！ * To optimise the CO, four determinants must be taken into account. The preload and contractility are the primary determinants of cardiac ejection (stroke volume). The association between these two parameters is described by the Frank-Starling mechanism. * Representation of the association between cardiac preload (ventricular end-diastolic filling volume) and stroke volume: up to a certain limit, the stroke volume increases with increasing preload (area of volume responsiveness). The optimal filling volume is reached when a further increase of the preload leads to no further or only a slight increase in stroke volume (target area). If there is a further increase in preload beyond this point, there is then a fall in the stroke volume as the cardiac muscle is over-stretched and so loses some of its contractility (volume overload). This curve can demonstrate different slopes and different areas for volume responsiveness and volume overload depending on the contractility of the ventricle. * With low contractility, the Frank-Starling curve is flatter, i.e. when contractility is low, the same increase in