经皮氧分压在危重症中步評估输液反應指標.ppt

Design and setting Single center, prospective, interventional study. 单一中心，前瞻性，介入的研究。 Intensive care units of a tertiary care teaching hospital. 一个大學級教学医院的重症监护病房。 This study was approved by the local ethics’ committee. 这项研究是由当地道德委员会的批准。 Materials and methods Patients for whom the attending physician decided to perform a fluid challenge in the immediate postoperative period. 患者的主治医生會决定即刻执行挑戰性的初期輸液在术后期間。 Presence of at least one clinical sign of inadequate tissue perfusion in the absence of contraindication for fluid infusion. 至少有一个组织灌注不足的的临床迹象下输液同時沒有禁忌症的存在。 Inclusion criteria 入选标准 Materials and methods Crit Care Med 2006; 34:1402–1407. Clinical signs of inadequate tissue perfusion组织灌注不足的临床症状 收缩压90毫米汞柱（或在以前的高血压患者减少 40毫米汞柱），或需要 vasopressive药物（多巴胺5微克/公斤/分钟或去甲肾上腺素）; 尿量0.5毫升/公斤/小时2小时; 室性心动过速（心率100/min）; 皮肤色斑的存在。 Crit Care Med 2006; 34:1402–1407. Materials and methods Exclusion criteria排除标准 年龄小于18岁。 怀孕。 被动直腿抬高试验的禁忌。 心律失常。 心源性肺水肿。 腹腔室隔综合征的存在。 拒绝参与这项研究。 Materials and methods Measurements All patients had an arterial catheter, a central venous catheter in place. All patients received infusions of morphine for analgesia and propofol for sedation. Transcutaneous partial pressure of oxygen (PtcO2) was measured with TCM3 system to evaluate regional perfusion. Noninvasive bioreactance CO monitoring was obtained using the NICOM? system Materials and methods Measurements测量 Serial measurements of HR, MAP, CVP were performed at baseline, during a PLR, and then during a 250 ml i.v. rapid NS infusion.进行一連串心跳,平均动脉压,中央静脉压定的测量,在PLR，然后在250毫升静脉注射快速的生理盐水输液。 Arterial and venous gases were obtained to determine pH, PaCO?, PaO?, HB, SaO?, ScvO? and lactate concentration at baseline.动脉和静脉气体，以确定pH值，PACO?，氧分压，HB，血氧饱和，中央靜脈血氧濃度和乳酸浓度 APACHE II and SAPS score were calculated. Materials and methods Protocol No other change in treatment was allowed during the protocol. 20min 10min Base1 10min 10min 10min 15min 250ml NS Materials and methods Semirecumbent position Supine position Schemat