picco监测及临床应用-课件.pptxVIP

picco监测及临床应用 ppt课件 1 l原理 l测定参数 l临床操作 l临床病例 l心排监测探讨 2 PiCCO原理 3 l l Pulse contour cardiac output pulse indicator continue cardiac output PiCCO 4 PiCCO采用成熟的热稀释方法测量单次 的心输出量(CO)， l 并通过分析动脉压力波形曲线下面积与 CO存在的一定关系，来获得连续的心输 出量(CCO) b. 动脉脉搏轮廓分析技术 a. 经肺热稀释技术 l 5 Picco技术获得连续CO的基本原理 lWesseling提出的心搏量同主动脉压力 曲线的收缩面积成正比，压力依赖于 顺应性及其系统阻力，并作了压力、 心率、年龄等影响因素校正后，该方 法才得到认可。 6 PULSION disposable pressure transducer PV8115 Arterial thermodilution catheter PiCCO plus setup Central venous catheter Connection cable to bedside monitor PMK - XXX7 Injectate temperature sensor cable PC80109 Injectate temperature 13.03 16.28 TB37.0 AP 140 117 92 (CVP) 5 SVRI 2762 PC CI 3.24 HR 78 SVI 42 SVV 5% dPmx 1140 (GEDI) 625 AP PCCI DPT Monitor cable PMK-206 AUX adapt cable PC81200 sensor housing PV4046 Interface cable PC80150 A. axillaris PV2014L08 4F 8 cm A. radialis 4F 50 cm A. femoralis PV2015L20 5F 20 cm PV2014L08* more than 10 kg bodyweight PV2013L07* 3F 7 cm Application sites for thermodilution catheters 8 *For application in pediatric patients PV2014L50LGWA (A. brachialis) Tb = Blood temperature Ti = Injectate temperature Vi = Injectate volume ∫ ∆ Tb . dt = Area under the thermodilution curv K = Correction constant, made up of specific specific heat of blood and injectate Tb injection Transpulmonary thermodilution: Cardiac Output Stewart-Hamilton method t 9 P [mm Hg] PCCO = cal • HRJ + C(p) • ) dt Systole t P d d R ) V (t S P Calculation of PCCO Model Patient- specific calibration factor (determined thermodilutio n) PCCO is displayed ab last 12s mean Aortic Shape of compliancperessure curve Area under pressure curve Heart rate t [s] 10 injection recirculation e-1 MTt MTt: Mean transit time ≈ half of the indicator passed the point of detection D