picco的监测与护理PPT课件.ppt

什么是PiCCO技术？ Pulse indicator Continous Cardiac Output;;中心静脉导管 颈内静脉 锁骨下静脉 温度指示剂注射;PiCCO plus 连接示意图;弹丸注射 ; 热稀释参数 心输出量 CO 全心舒张末期容积 GEDV 胸腔内血容积 ITBV 血管外肺水 EVLW 肺血管通透性指数 PVPI 心功能指数 CFI 全心射血分数 GEF;t [s]; 脉搏轮廓参数 脉搏连续心输出量 PCCO 每搏量 SV 心率 HR 每搏量变异 SVV 脉压变异 PPV 动脉压力 AP 系统血管阻力 SVR 左心室收缩指数 dPmx;如何测量心输出量（CO）;;Tb;;B. 动脉脉搏轮廓分析; 通过对分析每一次心脏跳动（beat by beat）时的动脉压力波型，得到连续的参数;;Goedje et al, Thorac Cardiovasc Surg 46: 242-249, 1998 ;容量的监测;目前判断心脏前负荷的标准; ;Lichtwarck-Aschoff et al, Intensive Care Med 18: 142-147, 1992;Lichtwarck-Aschoff et al, Intensive Care Med 18: 142-147, 1992;ln c (I);CO x MTt = volume of distribution = 1 + 2 + 3 + 4 + 5;CV bolus injection;ITTV = CO * MTtTDa;;Changes in stroke volume index (%);胸内血容量 ITBV;Relationship between ITBV and GEDV; Lichtwarck-Aschoff M. et al, Intensiv Care Med 18: 142-147, 1992;GEF =;dPmax =;血管外肺水 EVLW;Sakka et al: Intensive Care Med 26: 180-187, 2000;;Source Comparison Correlation Halperin et al, 1985 ? X-ray score vs. r = 0,51 Chest 88: 649 ? EVLW Baudendistel et al, 1982 X-ray score vs.EVLW 77 % J Trauma 22: 983 Sibbald et al, 1983 comparison cardiac edema r = 0,66 Chest 83: 725 comparison non cardiac edema r = 0,7 Sivak et al, 1983 X-ray score vs EVLW 64 % Crit Care Med. 11: 498 ? X-ray score vs. ? EVLW 42 % Laggner et al, 1984 X-ray score vs. EVLW r = 0,84 Intensive Care Med. 10: 309 Haller et al, 1985 X-ray score vs. EVLW 66 % Fortschr. R?ntgenstr. 142: 68 Eisenberg et al, 1987 X-ray score vs. EVLW 76 % Am Rev Resp Dis 136: 662 Takeda et al, 1995 X-ray score vs. EVLW X-ray insensitiveJ Vet Med Sci 57 (3): 481 ;PVPI = EVLW/PBV;肺血管通透性指数 2;在 81个重症 ICU病人中EVLW与死亡率的关系 Sturm, In: Practical Applications of Fiberoptics in Critical Care Monitoring, Springer Verlag Berlin - Heidelberg - NewYork 1990, pp 129-139;373位重症 ICU病人中EVLWI与死亡率的关系：其中193人感染，