休克与血流动力学监测ppt课件.pptVIP

* * To detect and quantify pulmonary oedema, PiCCO technology measures the extravascular lung water, which represents the water content of the lungs outside the blood vessels. It corresponds to the difference between the total intrathoracic distribution volume for cold (ITTV) and the blood volume in the thorax (ITBV). * Not only the degree of pulmonary oedema but also identification of its cause is important for guiding treatment. PiCCO technology measures the pulmonary vascular permeability index (PVPI), which provides information about the ratio between extravascular lung water and pulmonary blood volume. This ratio is a measure of the permeability of the pulmonary vascular bed, thus allowing differentiation between pulmonary oedema due to permeability (e.g. in sepsis) and hydrostatic pulmonary oedema (e.g. in cardiogenic shock). The PVPI can therefore provide important additional information for guiding treatment. SCVO2与乳酸的结合 容量--流量评价 * * 西安交大红会医院 组织氧合及微循环水平监测－－ Macroscopic level From Toe temperature to OPS Gastric tonometry Sublingual capnometry Laser Doppler flowmetry(mucosal perfusion) Indocyanine green clearance Near-infrared spectroscopy (NIRS). OPS（orthogonal polarization spectral imaging） 正交极化光谱图像 光源转换为550nm 血红蛋白为吸光点－天然造影剂 临床评估非常重要 皮肤温度 外周灌注指数 * * 西安交大红会医院 OPS * * 西安交大红会医院 OPS图像 正 常 Septic Shock Male 47 YMAP 68 mmHg, lactate 3.6 mEq/Ldopa 20 , ne 0.13 * * 西安交大红会医院 血流动力学监测其他重要内容 心肌收缩性 ---来源于PiCCO/心脏超声 后负荷 血管外肺水/肺血管通透性指数 ---EVLW/PVPI * * 西安交大红会医院 Contractility is a measure for the performance of the heart muscle 心肌收缩性是流量监测CO的必须补充 Contractility parameters of PiCCO technology: dPmx (maximum rate of the increase in pressure) GEF (Global Ejection Fraction) CFI (Cardiac Function Index) 心肌收缩性 kg kg * * 西安交大红会医院 来源于脉搏轮廓分析的心肌收缩性参数 dPmx = maximum velocity of pressure increase dPmx代表了左心室压力上升的最大速度 心肌收缩性 * * 西安交大红会医院 反映全心收缩性 GEF = Global Ejection Fraction 来源于热稀释法的心肌收缩性参数 4 x SV GEF = GEDV LA LV RA RV