picco监测的意义和影响因素.pptVIP

经肺热稀释 在中心静脉内注射冷（8oC）生理盐水作为指示剂 动脉导管尖端的热敏电阻测量温度下降的变化曲线 使用Stewart-Hamilton公式计算得出心输出量（CO） PiCCO测得的CO与肺动脉导管测得的CO相关良好 [s] 0 1 0 2 0 3 0 4 0 5 0 0 , 0 0 , 2 0 , 4 0 , 6 [ ° C ] - D T 注射 热稀释测量曲线 Tb = 血流温度 Ti = 注射指示剂温度 Vi = 注射指示剂容积 ∫ ? Tb . dt = 热稀释曲线下面积 K = 校正系数Correction constant, made up of specific weight and specific heat of blood and injectate 热稀释曲线下的面积与心输出量成反比 36,5 37 5 10 热稀释曲线 Normal CO: 5.5l/min 36,5 37 36,5 37 Time low CO: 1.9l/min High CO: 19l/min Time Time Temperature Temperature Temperature MTt: Mean Transit time 平均通过时间 the mean time required for the indicator to reach the detection point DSt: Down Slope time斜面下时间 the exponential downslope time of the thermodilution curve Recirculation t e-1 Tb From the characteristics of the thermodilution curve it is possible to determine certain time parameters 根据热稀释曲线可以算出时间参数 对热稀释曲线做进一步分析 Introduction to the PiCCO-Technology – Thermodilution Injection In Tb MTt DSt Tb = blood temperature; lnTb = logarithmic blood temperature; t = time Pulmonary Thermal Volume PTV肺内热容积 = Dst x CO By using the time parameters from the thermodilution curve and the CO ITTV and PTV can be calculated 计算 ITTV 与 PTV Introduction to the PiCCO-Technology – Thermodilution Recirculation t e-1 Tb Injection In Tb Intrathoracic Thermal Volume ITTV胸腔内热容积 = MTt x CO MTt DSt Pulmonary Thermal Volume (PTV) Intrathoracic Thermal Volume (ITTV) Calculation of ITTV and PTV Einführung in die PiCCO-Technologie – Thermodilution ITTV = MTt x CO PTV = Dst x CO RA RV LA LV PBV EVLW EVLW GEDV is the difference between intrathoracic and pulmonary thermal volumes Global End-diastolic Volume (GEDV) Volumetric preload parameters – GEDV RA RV LA LV PBV EVLW EVLW ITTV GEDV PTV Introduction to the PiCCO –Technology – Thermodilution Volumetric preload parameters – ITBV Intrathoracic Blood Volume (ITBV) GEDV ITBV PBV RA RV LA LV PBV EVLW EVLW Introduction to the PiCCO –Technology – Thermodilution ITBV is the total