休克患者血容量监测VIP免费

休克患者血容量监测内容简介容量管理的基本目标容量监测的现状及局限性容量监测的进展ITBV的应用SVV的应用EVLW的应用小结休克的概念感染、创伤、烧伤等引起有效循环血量明显减少组织器官的灌注不足氧输送不能满足组织代谢需要导致组织缺氧代谢障碍和细胞受损临床综合征休克治疗的首要任务：积极、合适补充血容量休克发生的始动因素：有效循环血量下降合适的容量管理容量管理的基本目标保证容量－合适的心脏前负荷预防肺水肿二者必须平衡内容简介容量管理的基本目标容量监测的现状及局限性容量监测的进展ITBV的应用SVV的应用EVLW的应用小结容量监测的现状容量监测：TEE，CT，核素扫描临床表现:血压、心率、尿量、皮肤粘膜等压力监测：漂浮导管(CVP/PAWP)心脏前负荷：VEDVRVEDP/LVEDP的测定压力反映容量及肺水肿的局限性心脏顺应性瓣膜功能肺毛细血管通透性机械通气对循环的影响PAC对容量监测的有效性和可信性受到置疑？？许多文献：CVP/PAWP不能准确反映容量状态PrincipleofEVLWmeasurementPrincipleofEVLWmeasurementRAEDVRAEDVLAEDVLAEDVLVEDVLVEDVPBVPBVRVEDVRVEDVEVLWInjectionPiccoThermo-dilutioncatheterSwan-ganzcatheter呼吁容量指标的应用来反映容量状态及肺水肿内容简介容量管理的基本目标容量监测的现状及局限性容量监测的进展ITBV的应用SVV的应用EVLW的应用小结AphysiologicalsystemmodelAphysiologicalsystemmodelITTV:IntrathoracictotalvolumeITTV:IntrathoracictotalvolumeGEDV:Globalend-diastolicvolumeGEDV:Globalend-diastolicvolumeITBV:IntrathoracicbloodvolumeITBV:IntrathoracicbloodvolumePTV:PulmonarytotalvolumePTV:PulmonarytotalvolumeEVLW:extra-pulmonarylungwaterEVLW:extra-pulmonarylungwater胸內总容量全心舒张期血容量胸內血液容量肺部容积血管外肺水容量指标的应用胸腔内血管容量(ITBV)血管外肺水(EVLW)搏出量变异率(SVV)胸腔内血管容量(ITBV)左心舒张末期容量右心舒张末期容量肺血容量搏出量变异率搏出量变异率(SVV)(SVV)SVV=(SVmax–SVmin)/SVmeanSvmax:meanvalueoffourSVmax/30sSVmin:meanvalueoffourSVmin/30sSVmean血管外肺水组成血管外肺水组成(EVLW)(EVLW)细胞内液细胞内液间质液体间质液体肺泡内液体肺泡内液体内容简介管理的基本目标容量监测的现状及局限性容量监测的进展ITBV的应用SVV的应用EVLW的应用小结ITBV—validestimateofpreloadinALIProspectiveanimalstudy15sheepwithALI---salinewashoutMV(PEEP0,7,14,21respectively60min)Measurement:LVEF,LVEDV-----CTscanITBV,RVEDV---PiCCOCVP,PAWP----PACLueckeT,etal.IntensiveCareMed,2004,30:119-126LueckeT,etal.IntensiveCareMed,2004,30:119-126LueckeT,etal.IntensiveCareMed,2004,30:119-126ITBVandRVEDVProvidevalidestimateofpreloadEvenathighintrathoracicpressureITBV----indicatorofpreloadinlivertransplantation60patientsundergoingLivertransplantationmonitoredwithPiCCOandPACthecorrelationbetweenPAOPandITBVIwithrespecttoCIandSVIthecorrelationbetweenITBVIandPAOPDellaRoccaG,etal.EurJAnaesthesiol.2002,19:868-750.470.550.020.0150.00200.10.20.30.40.50.6相关系数rITBV-CIITBV-SVIPAWP-CIPAWP-SVIPAWP-ITBVITBVI----morereliableindicatorofpreloadthanPAWPDellaRoccaG,etal.EurJAnaesthesiol.2002,19:868-75ITBVI---validindicatorofpreloadinlungtransplantation50patientsduringlungtransplantationTime:6phaseduringoperationCorrelationbetweenPAWPandSVICorrelationbetweenITBVIandSVICorrelationbetween(Delta)ITBVI\PAWPandDeltaSVIDeltawerecalculatedbysubtractingthefirstfromthesecondmeasurementDellaRG,etal.AnesthAnalg.2002,95:835-43ITBV---superiorthanPAWPinpreloadITBV---superiorthanPAWPinpreload0.410.0200.050.10.150.20.250.30.350.40.45rITBV-SVIPAWP-SVIDellaRG,etal.AnesthA...