ICU血流动力学监测和PICCO技术VIP免费

ICU血流动力学监测和PICCO技术第一页，共四十三页。ICU患者的输液治疗的决定因素临床经验中心静脉压(CVP)肺动脉楔压(PAWP)BoldtJ,LenzM,KumleB,PapsdorfM.Volumereplacementstrategiesonintensivecareunits:resultsfromapostalsurvey.IntensiveCareMed1998;24:147-151第二页，共四十三页。ICU患者的输液治疗的决定因素临床经验中心静脉压(CVP)肺动脉楔压(PAWP)BoldtJ,LenzM,KumleB,PapsdorfM.Volumereplacementstrategiesonintensivecareunits:resultsfromapostalsurvey.IntensiveCareMed1998;24:147-151第三页，共四十三页。临床评价vs.血流动力学目的:评价肺动脉导管(PAC)得到的血流动力学指标是否能够改变患者的治疗设计:前瞻性观察患者:103例留置PAC的患者方法:–插管前,请医生对一些血流动力学指标的范围,诊断及治疗方案进行预测–插管后,复习患者病例,记录插管时及置管8小时内的血流动力学EisenbergPR,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-553第四页，共四十三页。临床评价vs.血流动力学0%20%40%60%PAWPCOSVRRAP预测准确性EisenbergPR,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-553第五页，共四十三页。临床判断缺乏准确性:PAWP01015191915100预计PAWP(mmHg)测定PAWP(mmHg)EisenbergPL,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-553NochangeinplannedtherapyaftercatheterizationChangeinplannedtherapyaftercatheterization第六页，共四十三页。0临床判断缺乏准确性:CO04.57.0预计CO(L/min)测定CO(L/min)EisenbergPL,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-5534.57.0第七页，共四十三页。临床判断缺乏准确性EisenbergPL,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-553参数判断正确数目/测定数目正确率(%)PAWP31/10230CO49/9751SVR39/8844RAP54/9855第八页，共四十三页。ICU患者的输液治疗的决定因素临床经验中心静脉压(CVP)肺动脉楔压(PAWP)BoldtJ,LenzM,KumleB,PapsdorfM.Volumereplacementstrategiesonintensivecareunits:resultsfromapostalsurvey.IntensiveCareMed1998;24:147-151第十页，共四十三页。压力有时不能代表前负荷左室舒张末容积〔LVEDV，真实的左室前负荷〕肺动脉阻塞压〔PAOP〕第十一页，共四十三页。CVP/PAWP不能预测扩容反响Lichtwarck-Aschoffetal,IntensiveCareMed1992;18:142-147第十二页，共四十三页。何去何从第十三页，共四十三页。PICCO技术第十四页，共四十三页。CentralvenouscatheterInjectatetemperaturesensorhousingPV4046ArterialthermodilutioncatheterInjectatetemperaturesensorcablePC80109PULSIONdisposablepressuretransducerPV8115PCCIAP13.0316.28TB37.0AP14011792(CVP)5SVRI2762PCCI3.24HR78SVI42SVV5%dPmx1140(GEDI)625DPTMonitorcablePMK-206InterfacecablePC80150ConnectioncabletobedsidemonitorPMK-XXXAUXadaptercablePC81200第十五页，共四十三页。PiCCO的技术原理PiCCO技术由以下两种技术组成,用于更有效地进行血流动力和容量治疗,使大多数病人不必使用肺动脉导管:a.经肺热稀释技术b.动脉脉搏轮廓分析技术第十六页，共四十三页。PiCCO容量参数全心舒张末期容积GEDV胸腔内血容积ITBV血管外肺水EVLW通过对热稀释曲线的分析,可以得到这些容量参数lnc(I)注射At再循环MTtte-1DStc(I)第十七页，共四十三页。全心舒张末期容积(GEDV)全心舒张末期容积(GEDV)是心脏4个腔室内的血容量第十八页，共四十三...