PICCO监测和护理精编PPT课件.ppt

* 胸腔内血容积（Intrathoracic Blood Volume，ITBV）是全心舒张末期容积（GEDV）+ 肺血管内血液容积（PBV） ITBV = PBV + GEDV RVEDV LAEDV LVEDV PBV RAEDV ITBV 最初用染料稀释法得到（双指示剂法，COLD系统），并显示与通过热稀释法测量得到的GEDV之间存在着相关性 ITBV = 1.25 x GEDV ITBVTD (ml) r = 0.96 ITBV = 1.25 * GEDV – 28.4 [ml] GEDV vs. ITBV in 57 intensive care patients Sakka et al, Intensive Care Med 26: 180-187, 2000 血管外肺水 EVLW EVLW RAEDV RVEDV LAEDV LVEDV PTV EVLW ITBV ITTV RAEDV RVEDV LAEDV LVEDV PBV 血管外肺水（Extravascular Lung Water，EVLW）反映肺间质内含有的水量，通过ITTV与ITBV之差得到 ITTV = CO * MTtTDa PTV = CO * DStTDa ITBV = 1.25 * GEDV EVLW = ITTV - ITBV GEDV = ITTV - PTV RAEDV RVEDV LAEDV LVEDV RAEDV RVEDV LAEDV LVEDV PBV RAEDV RVEDV LAEDV LVEDV PTV PTV EVLW EVLW 容量计算——小结 PICCO 胸腔内总热容积=心输出量*指示剂通过系统需要的时间 肺内热容积=心输出量*热稀释曲线下降时间 全心舒张末期容积=胸腔总热容积-肺内热容积 胸腔血容积=1.25*全心舒张末期容积 血管外肺水=胸腔总热容积-胸腔血容积 正常值范围 Parameter Range Unit CI 3.0 – 5.0 l/min/m2 SVI 40 – 60 ml/m2 SVRI 1200 – 1800 dyn*s*cm-5* MAP 70 – 90 mmHg GEF 25 – 35 % CFI 4.5 – 6.5 1/min HR 60 – 90 1/min GEDVI 680 – 800 ml/m2 ITBVI 850 – 1000 ml/m2 SVV ? 10 % EVLWI 3.0 – 7.0 ml/kg PVPI 1.0 – 3.0 Decision tree for hemodynamic / volumetric monitoring CI (l/min/m2) GEDI (ml/m2) or ITBI (ml/m2) ELWI* (ml/kg) (slowly responding) 3.0 3.0 700 850 700 850 700 850 700 850 ELWI* (ml/kg) GEDI (ml/m2) or ITBI (ml/m2) CFI (1/min) or GEF (%) 10 10 10 10 10 10 10 10 V+ V+! V+! V+ Cat Cat OK! V- 700 850 700-800 850-1000 4.5 25 5.5 30 4.5 25 700-800 850-1000 Cat 5.5 30 700 850 700-800 850-1000 700-800 850-1000 ?10 ?10 ?10 ?10 V- V+ = volume loading (! = cautiously) V- = volume contraction Cat = catecholamine / cardiovascular agents ** SVV only applicable in ventilated patients without cardiac arrhythmia 700 850 10 Optimise to SVV** (%) 10 10 10 R E S U L T S T A R G E T T H E R A P Y 1. 2. Without guarantee 10 10 10 10 * not available in the USA (p 63) PICCO 影响PICCO的因素？ 影响PICCO的因素？ 影响 PICCO 监测 因素 导管放置不正确 每次进行动脉 压修正后， 未通过热稀释 测量方法对动 脉轮廓分析法 重