容量复苏治疗阶段性2015.pptVIP

前负荷 ITBW GEDV 心功能 SV(SVI) CO(CI) GEF CFI dpmx 后负荷 SVRI 渗透性 or 漏出性 PVPI 肺水情况 EVLW 容量反应性监测：SVV、PPV 生命体征　 9月23日 MAP(mmHg) 117 HR(次/分) 114 CVP（mmHg）/膀胱压 18/26 心功能 CI (3.0-5.0) 4.0 SVI (40-60) 33 CFI (4.5-6.5) 10 GEF (25-35%) 33 dPmx (1200-2000) 1510 后负荷： SVRI (1700-2400) 2190 前负荷： GEDI (680-800) 410 肺水： ITBI (850-1000) 512 ELWI (3.0-7.0) 6 肺通透性：PVPI (1.0-3.0) 2.1 容量反应性：SVV/PPV ﹣ PiCCO 血压低 心率快 每搏量低 容量不足 需要扩容 但考虑呼吸与腹压给予了脱水 禁食，胃肠减压 抑制胰液分泌：制酸剂、生长抑素、乌司他丁 呼吸、心脏等脏器功能支持治疗 B超引导腹腔穿刺引流 维持内环境稳定 CT检查、床边胸片检查 CVVH脱水(-1866ml) 对容量有反应 ? 需要给予立即扩容 仍需考虑是否肺、肝或脑组织有脱水的需要 生命体征　 9月23日 9月24日 MAP(mmHg) 117 98 HR(次/分) 114 120 CVP/膀胱压（mmHg） 18/26 13/21 心功能 CI ( 3.0-5.0) 4.0 2.67 SVI (40-60) 33 21 CFI (4.5-6.5) 10 8 GEF (25-35%) 33 26 dPmx (1200-2000) 1510 1030 后负荷： SVRI (1700-2400) 2190 2520 前负荷： GEDI (680-800) 410 411 肺水： ITBI (850-1000) 512 513 ELWI (3.0-7.0) 6 10 肺通透性：PVPI (1.0-3.0) 2.1 3.3 容量反应性：SVV/PPV ﹣ 心率更快 每搏量更低 容量更不足 扩容 治疗2天后表现 液体平衡： 第1天： -1866ml 第2天： +2550ml 心率85-95次/分, 血压平稳 呼吸机支持，PaO2/FiO2 160mmHg 如何把握容量状态及个体化治疗？ 容量监测与个体化容量治疗 了解各个容量监测参数的局限性 了解各个重症个体的特殊性 了解各个重症阶段治疗的特殊性 谢谢聆听！ * * * * Supporting findings by Rady et al we found that 56.5% of the control group versus 8% of the treatment group had continued evidence of global tissue hypoxia at 6 hours. Failure to reach an Scv02 60% at 6 hours was associated with a 40% of mortality in both groups. * * Patients’ HR, MAP, and SI were measured at triage. After some therapy, they were improved. However, ScvO2 was low and Lactate was still high at this phase. Further therapy was required to improve tissue hypoxia while vital signs remained unchanged. These results further emphasize that vitals signs alone are not adequate resuscitation end points. * * One of the key components in our study was early identification of cryptic shock. 33 and 30 patients in the control and treatment groups, respectively, were enrolled