PICCO参数解读和血流动力学原理.pptVIP

EVLWI 解决了如下问题: 肺血管通透性指数和临床的关系 PVPI 解决了如下问题: 综上可以对有效治疗提供有价值的帮助！ 肺水有多少? 为什么会有这些量的肺水? 四、后负荷参数 系统血管阻力 SVR = Systemic Vascular Resistance 反映后负荷的连续性指标 正常值：1700-2400 dyn*s*cm-5*m2 Normal ranges PiCCO血流动力/容量管理决策树 * Most hemodynamic unstable and/or severely hypoxemic patients are instrumented with CVP and arterial line~ Using PiCCO only requires any standard CV-line and a thermistor-tipped arterial PiCCO-catheter instead of the standard arterial line. * PiCCO技术－结合经肺热稀释方法和动脉脉搏轮廓分析法 对血液动力学和容量进行监护管理。 需要提醒的是picco技术显示的参数并不都是实时的，这个我们也很容易理解，所谓热稀释方法肯定要有稀释才能够有参数，所以是打一次冰水得到一次参数 那么根据动脉轮廓分析得到的参数，顾名思义，病人的脉搏是连续不断的，所以这一部分的参数是实时连续的 这个讲义里面省略了很多计算内容，包括这么多的参数是怎么得出的还有验证参数准确性的各种研究，容量的估算啊，还有动脉轮廓如何校准 有超过200个的学术研究已经论证了PiCCO技术所提供的这些数据在临床应用中的准确性和方便性。我们可以提供详尽的文献。 进两年以来学术研究的方向已经从论证PiCCO的可信度转变为借助PiCCO来论证其他的临床课题。例如Effect of the venous catheter site on transpulmonary thermodilution measurement variables. Critical Care Medicine. 35(3):783-786, March 2007.Schmidt, Sven MD 这里归纳了picco技术所能监测的所有参数，之后我们会就其中有重大意义的参数详细解释 * To optimise the CO, four determinants must be taken into account. The preload and contractility are the primary determinants of cardiac ejection (stroke volume). The association between these two parameters is described by the Frank-Starling mechanism. * Representation of the association between cardiac preload (ventricular end-diastolic filling volume) and stroke volume: up to a certain limit, the stroke volume increases with increasing preload (area of volume responsiveness). The optimal filling volume is reached when a further increase of the preload leads to no further or only a slight increase in stroke volume (target area). If there is a further increase in preload beyond this point, there is then a fall in the stroke volume as the cardiac muscle is over-stretched and so loses some of its contractility (volume overload). This curve can demonstrate different slopes and different areas for volume responsiveness and volume overload depending on the contractility of the ventricle. * With