6.3休克基础监护及治疗进展PPT.ppt

休克基础监护及治疗进展;休克基础;概念;概念;休克历史与发展;80年前;８０年代;９０年－－;休克分类;低血容量性休克;心源性休克;分布性休克;梗阻性休克;发病机制;休克血流动力学监测;基础理论;ＣO;ABC理论;氧输送监测;血流动力学监测目的;血流动力学监测的重点;血流动力学－监测方法与进展;前负荷及评估容量反应性;Current Opinion in Critical Care 2005, 11:264—270;前负荷及评估容量反应性;Elastic band demonstrating the concept of unstressed volume. There is no tension in the wall of the elastic until it is stretched beyond the resting volume;前负荷及评估容量反应性;右室舒张末容积(RVEDV/CEDV) (pulmonary artery thermodilution) 肺动脉漂浮导管;GEDVI － PiCCO system better reflects left ventricular preload than CEDVI －pulmonary artery catheter;思 考;思 考;前负荷及评估容量反应性;Date;Date;Date;容量反应性的方法;容量反应性的方法;容量反应性的方法;前负荷/容量反应性和治疗策略;CO的测量及进展; ;CO的测量方法－有创;血流动力学监测革命的第一步;＞;Swan-Ganz导管;进 步;PAC的作用;没有坏处 可能有益处 1.在休克或ARDS病人PAC的应用不影响 28-day mortality duration of stay in the ICU or hospital 2.应用于创伤引起的ARDS病人--目前唯一的好结果 Trauma patients managed with a PAC are more severely injured and have a higher mortality Survival benefit when managed with a PAC Injury Severity Score of 25–75 BE of less than 11 age of 61–90 yrs;PAC的作用;;PAC何时用？;t [s];CO测量－微创;PiCCO;PiCCO与Swan-Ganz热稀释导管测量心输出量的异同;PiCCO的专有公式;CO测量－微创;CO测量－微创;CO的测量方法－无创;USCOM;TEE;Date;CO的测量方法－无创;Date;CO监测应用临床现状;CO测量方法的选择;;CO监测何时用？;CO监测的未来研究方向;组织氧合及微循环水平监测－微观代谢水平;LAC清除率;SVO2SCVO2; SvO2 indicator of the VO2 / DO2 balance;Percentage error = 2 SD/mean reference value = 11%;Date;Date;SVO2/SCVO2监测相关的治疗策略;N Engl J Med 2001;345:1368-77;Rivers et al NEJM 2001 ;;Early and aggressive treatment of circulatory failure based on a physiologic protocol targeting ScvO2 results in a better outcome ;Date;SVO2/SCVO2监测相关的治疗策略;组织氧???及微循环水平监测－－ Macroscopic level ;OPS;OPS图像;;;;; is calculated as 4 times the stroke volume divided by the global end-diastolic volume reflects both left and right ventricular contractility;; is - similar to the GEF a parameter of both left and right ventricular contractility; 心血管状态信息的重要 控制容量和血管活性药物应用的重要决定因素; dPmx 左室功能 GEF and CFI 全心功能 SVR 心血管状态信息的重