休克患者血容量监测进展PICCO－杨毅.ppt

休克的概念 感染、创伤、烧伤等 引起有效循环血量明显减少 组织器官的灌注不足 氧输送不能满足组织代谢需要 导致组织缺氧 代谢障碍和细胞受损 临床综合征 休克治疗的首要任务： 积极、合适补充血容量 容量管理的基本目标 容量监测的现状 容量监测：TEE，CT，核素扫描 临床表现: 血压、心率、尿量、皮肤粘膜等 压力监测：漂浮导管(CVP/PAWP) RVEDP/LVEDP的测定 压力反映容量及肺水肿的局限性 心脏顺应性 瓣膜功能 肺毛细血管通透性 机械通气对循环的影响 Principle of EVLW measurement A physiological system model 容量指标的应用 胸腔内血管容量(ITBV) 血管外肺水(EVLW) 搏出量变异率(SVV) 胸腔内血管容量(ITBV) 左心舒张末期容量 右心舒张末期容量 肺血容量 搏出量变异率(SVV) SVV=(SVmax – SVmin)/SVmean Svmax:mean value of four SVmax/30s SVmin :mean value of four SVmin/30s SVmean 血管外肺水组成(EVLW) 细胞内液 间质液体 肺泡内液体 ITBV—valid estimate of preload in ALI Prospective animal study 15 sheep with ALI ---saline washout MV(PEEP 0,7,14,21 respectively 60min) Measurement: LVEF,LVEDV-----CT scan ITBV,RVEDV---PiCCO CVP,PAWP----PAC ITBV----indicator of preload in liver transplantation 60 patients undergoing Liver transplantation monitored with PiCCO and PAC the correlation between PAOP and ITBVI with respect to CI and SVI the correlation between ITBVI and PAOP ITBVI --- valid indicator of preload in lung transplantation 50 patients during lung transplantation Time: 6 phase during operation Correlation between PAWP and SVI Correlation between ITBVI and SVI Correlation between (Delta) ITBVI \ PAWP and Delta SVI Delta were calculated by subtracting the first from the second measurement Della RG, et al. Anesth Analg. 2002 , 95: 835-43 ITBV--- superior than PAWP in preload ITBV correlated significantly with CI and SV IN CABG Prospective, controlled, clinical study 18 patients with ejection fraction 50% undergoing coronary artery bypass graft surgery A baseline measurement :after induction of anesthesia (T1) treated by infusion of 6% hydroxyethyl starch 200/0.5 (7 mL/kg) After 10 minutes, a second measurement (T2) was performed ?ITBV has Good relationship between CI/SVI ITBV/GEDV---good preload indicator in heart transplantation 前瞻性临床研究 40例心脏移植术后患者 男34例，女6例 观察术后3、6、12、24、36、48、72h ITBV/GEDV和CVP/PAWP与SV的相关性 ITBV的改