机械通气的血流动力学效应—刘大为-课件，幻灯，PPT.pptVIP

前负荷 静态测量反映前负荷指标有明确的局限性 CVP, RAP, PAOP 心室容积 不应单独应用某个指标代表前负荷 动态监测容易受多种因素影响 Take home message 尝试应用反映组织灌注的参数作为目标 压力或容积参数只用于手段，不是目的 压力不代表容积 CVP是反映心脏前负荷的重要指标 维持CVP在尽可能低的水平 好的参数：不在于它的复杂而在于它的被理解和被应用 A 43-year-old man presented to the emergency room in respiratory distress after a 3-week illness. He had a history of alcoholism but no other serious illness. He had a respiratory rate of 34 breaths per minute, a heart rate of 120 beats per minute, a blood pressure of 80/50 mm Hg, and oxygen saturation of 86% while breathing ambient air. On examination, his neck veins were grossly distended (Panel A) and breath sounds were absent on the right side. Chest radiography revealed complete opacification of the right lung field (Panel B). The right side of the diaphragm was inverted and compressing the liver inferiorly, and the heart was hyperkinetic and severely compressed. Computed tomography showed a large collection of liquid in the right pleural space with a marked mediastinal shift and compression of the heart and great vessels toward the left side of the chest wall (Panel C). Six liters of pus was drained with the use of a 24-French chest tube, and the heart rate decreased to 90 beats per minute, the blood pressure normalized to 110/60 mm Hg, and the elevated jugular venous pressure immediately resolved (Panel D). The microbiologic culture yielded Streptococcus anginosus and S. constellatus, organisms that appeared to be associated with aspiration pneumonia. The patient was treated with ceftriaxone and clindamycin. After local fibrinolytic therapy and thoracoscopy with decortication, he had a full recovery. Schematic diagram of RM methods tested. Top panel, sustained inflation; continuous positive airway pressure (CPAP) was held at 45 cm H2O for 40 secs. Middle panel, incremental positive end-expiratory pressure (PEEP); PEEP was increased in 5-cm H2O increments (allowing 30 secs/step) from a baseline PEEP of 8 cm H2O to 35 cm H2O while decreasing tidal volume (VT) to limit