中PiCCO的应用课件.pptVIP

PiCCO容量监护仪在ICU中的应用;;;;;PiCCO技术可以监测心输出量;;Transpulmonary thermodilution method;;;;Transpulmonary thermodilution CO measurement (vs PA thermodilution);;PCCO = cal . HR . ? (P(t)/SVR + C(p) . dP/dt) dt;Validation of continuous cardiac output measurement by the pulse contour analysis (PiCCO system) PiCCO所得连续心排量数值准确性论证;; ;目前医学界判斷心脏前負荷的标准;;;Raper R and Sibbald WJ. Chest 1986 Misled by the wedge ? The Swan-Ganz catheter and left ventricular preload.;GEDV可以作为心脏前负荷的指标;CO x MTt = volume of distribution = 1 + 2 + 3 + 4 + 5;CO x MTt = volume of distribution = 1 + 2 + 3 + 4 + 5;CO x MTt = volume of distribution = GEDV + PBV + EVLW;Changes in stroke volume index (%);治疗指南－Surviving Sepsis Campaign Guidelines 2008: ? 灌注压在评估扩容治疗中已经被证实有局限性 ... 使用血流量或者容量参数指导容量管理或许更有优势 … 这些技术已经能够在ICU内实现 …? ;Intrathoracic pressure Venous return to left and right ventricle Left ventricular preload Left ventricular stroke volume Systolic arterial blood pressure;; SVV 反映了心脏对因机械通气导致的前负荷周期性变化的敏感性。1,15,18,19,20 SVV 可用于预测扩容治疗对每搏量的提高程度。1,15,18,19,20;;心肌收缩状况;; TEE FAC;;;PiCCO心肌收缩力参数;全心射血分数（GEF） （经肺热稀释导管）;;;;;CO x MTtcold = cold indicator volume of distribution;;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 ;;373位重症 ICU病人中EVLWI与死亡率的关系：其中193人感染，49人ARDS， 48人头部创伤，83人出血性休克。 根据EVLW的数值病人分成四组