PiCCO基本杂氕理.pptVIP

PMAN\FREIDOKU\SCHULUNG\PiCCO\high_level\PiCCO_highLevelV05_04_02 PMAN\FREIDOKU\SCHULUNG\PiCCO\PiCCO_highLevelV04_08_00 PMAN\FREIDOKU\SCHULUNG\PiCCO\PiCCO_highLevelV04_08_00 Fick法：利用血氧饱和度来测量CO，SvO2=SaO2-VO2/[CO x Hgb] 容量 药物 3.临床应用 Drugs Volume 现在的情况如何?.………..……..………………………………心输出量! 前负荷如何?.………………......….………………......…全心舒张末期容积! 容量会升高CO吗?....………...………..………………......…每搏量变异! 后负荷如何?……………..…...………………......…系统血管阻力! 肺是否干燥?...…….……...…..…..………………......…血管外肺水! PiCCO 回答下列相关问题 CO GEDV SVV SVR EVLW * not available in the USA (p 63) 胸腔内血容积（ITBV）和全心舒张末期容积（GEDV）在反映心脏前负 荷方面不但敏感性和特异性优于常规使用的心脏充盈压力 CVP + PCWP，而且也优于右心室舒张末期容积2,3,5,6,8,9,13,14,23 ITBV和GEDV的显著优点是不受机械通气的影响，可以更准确地反映前 负荷的情况2,3,6,7,8,9,13,14, 23 PiCCO前负荷指标 压力和容量反映前负荷 1 心指数（ΔCI）变化与中心静脉压（ΔCVP）、肺楔压（ΔPCWP）和胸腔内血容积（ΔITBI）变化的关系，病人是急性呼吸衰竭采用机械通气13 Lichtwarck-Aschoff et al, Intensive Care Med 18: 142-147, 1992 压力和容量反映前负荷 2 ?ITBV (and thus GEDV) seems to be a better indicator of left ventricular preload than PCWP“ Hoeft A, Yearbook of Intensive Care and Emergency Medicine, 1995 11 热稀释法测量得到的血管外肺水（ EVLW）已经被双指示剂法和重量法的测量结果验证12,17,22,24 血管外肺水（ EVLW）显示与ARDS的严重程度、机械通气天数、住ICU时间及死亡率明确相关，在评估肺水肿方面优于胸部X线7,8,16,21,24,25 血管外肺水 Source Comparison Correlation Baudendistel et al, 1982, J Trauma 22: 983 X-ray score vs.EVLW* 77 % Sibbald et al, 1983, Chest 83: 725 comparison cardiac edema r = 0,66 comparison non cardiac edema r = 0,7 Sivak et al, 1983, Crit Care Med. 11: 498 X-ray score vs EVLW* 64 % ? X-ray score vs. ? EVLW* 42 % Laggner et al, 1984, Intensive Care Med. 10: 309 X-ray score vs. EVLW* r = 0,84 no / low / high PE, estimated by radiologists Halperin et al, 1985, Chest 88: 649 ? X-ray score vs. ? EVLW* r = 0,51 Haller et al, 1985, Fortschr. R?ntgenstr. 142: 68 X-ray score vs. EVLW* 66 % Eisenberg et al, 1987, Am Rev Resp Dis 136: 662 X-ray score vs. EVLW* 76 % Takeda et al, 1995, J Vet Med Sci 57 (3): 481 X-ray score vs. EVLW* X-ray insensitive EVLW和