血管外肺水的定量评估讲述.pptxVIP

血管外肺水的定量评估;血管外肺水的定义; The pathological condition of pulmonary edema develops by two mechanisms: An increase in the pulmonary capillary hydrostatic pressure (hydrostatic or cardiogenic pulmonary edema) and an increase in pulmonary capillary permeability (acute respiratory distress syndrome [ARDS]). However, it is often difficult to discriminate between edema caused by increased hydrostatic pressure in the course of cardiac disease, or by increased permeability associated with ARDS 肺水肿的发生机制有两种：1.肺毛细血管的静水压增高（静水压或者心源性肺水肿）。2.毛细血管通透性增高（ARDS）。然而临床上有时很难区别这两种病因。前者进入肺间质和肺泡的主要是水分，而后者除了水分外还有大量蛋白等组织成分;AECC和柏林标准诊断ARDS存在的问题 ;Am J Respir Crit Care Med. 2013 ,187(7):761-7.; If we are to require positive pressure ventilation in our definition, why not consider lung water – is it not time to move forward？ If not EVLW then perhaps deadspace fraction, or the distribution of injury and/or lung weight by Cat Scan, or a direct measure of permeability – some more direct measure of injury specifi c to ARDS.;Conclusions: A definite correlation exists between EVLW measured by the single-indicator transpulmonary thermodilution technique and post-mortem lung weight in humans;Crit Care Med. 2013 Sep;41(9):2144-50.;EVLWI与ARDS发病前状态及ARDS的关系;弹丸注射 ;11;12;血管外肺水与血管外肺水指数;Crit Care Med. 2008 June ; 36(6): 1803–1809;Crit Care Med. 2008 Jan;36(1):69-73.;Crit Care Med. 2008 Jan;36(1):69-73.;预计体重的计算公式;Crit Care Med. 2012 March ; 40(3): 847–854;Crit Care Med. 2012 March ; 40(3): 847–854;问题;21;Annual update in intensive care and emergenct medicine 2014,p 259;Kushimoto et al. Critical Care 2012, 16:R232;Annual update in intensive care and emergenct medicine 2014,p 263;Examples: Interpretation of EVLW and PVPI Values;Examples: Interpretation of EVLW and PVPI Values;Examples: Interpretation of EVLW and PVPI Values;总结;谢谢各位老师的聆听