最新深静脉穿刺置管术PPT演示课件.ppt

. * What parameters are available for measuring the preload? - classical parameters: cardiac filling pressures CVP (via CVC) and PCWP (via pulmonary arterial catheter) - static volumetric preload parameters: GEDV (global end-diastolic volume and ITBV (intrathoracic blood volume) - dynamic parameters SVV (stroke volume variation) and PPV (pulse pressure variation). In the narrower sense, these are not preload parameters but parameters of the heart‘s preload responsiveness (reaction of cardiac stroke volume to volume administration) * The relevance of the filling pressures for assessing cardiac preload has long been disputed and has been refuted in numerous publications. Neither the absolute level of the CVP (shown on left) nor the changes in CVP (shown on right) correlate with stroke volume. CVP therefore not suitable for assessing volume status. * The pulmonary capillary wedge pressure (PCWP) and alterations of this do not show any correlation with cardiac ejection either. Thus measurement of cardiac preload is not possible by means of the traditionally employed PCWP either. * FACCT study by the ARDS Networks, published in the New England Journal of Medicine: no difference in the outcome of ARDS patients with CVP-guided fluid management and those with volume therapy guided by the PCWP. Better: measure volumes directly instead of estimating them from the pressure measurement. The level of the filling pressures is subject to many influencing factors so a valid statement about volume status is not possible. Only exception: low filling pressures indicate hypovolaemia（血容量减少） * Introduction to the volumetric preload parameters. These allow direct measurement of the cardiac filling volume so that this does not have to be estimated through a pressure measurement. * The global end-diastolic volume consists of the end-diastolic volumes of all four cardiac chambers. Even if this volume does not exist physiologically (diastole of all four cardiac chambers is not simultaneous)