ICUICU血流动力学监测和血流动力学监测和PICCOPICCO技术技术ICUICU患者的输液治疗的决定因素患者的输液治疗的决定因素临床经验临床经验中心静脉压中心静脉压(CVP)(CVP)肺动脉楔压肺动脉楔压(PAWP)(PAWP)BoldtJ,LenzM,KumleB,PapsdorfM.Volumereplacementstrategiesonintensivecareunits:resultsfromapostalsurvey.IntensiveCareMed1998;24:147-151ICUICU患者的输液治疗的决定因素患者的输液治疗的决定因素临床经验临床经验中心静脉压中心静脉压(CVP)(CVP)肺动脉楔压肺动脉楔压(PAWP)(PAWP)BoldtJ,LenzM,KumleB,PapsdorfM.Volumereplacementstrategiesonintensivecareunits:resultsfromapostalsurvey.IntensiveCareMed1998;24:147-151临床评价临床评价vs.vs.血流动力学血流动力学目的目的::评价肺动脉导管评价肺动脉导管(PAC)(PAC)得到的血流动力学得到的血流动力学指标是否能够改变患者的治疗指标是否能够改变患者的治疗设计设计::前瞻性观察前瞻性观察患者患者:103:103例留置例留置PACPAC的患者的患者方法方法::–插管前插管前,,请医生对一些血流动力学指标的范围请医生对一些血流动力学指标的范围,,诊断诊断及治疗方案进行预测及治疗方案进行预测–插管后插管后,,复习患者病例复习患者病例,,记录插管时及置管记录插管时及置管88小时内小时内的血流动力学的血流动力学EisenbergPR,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-553临床评价临床评价vs.vs.血流动力学血流动力学0%20%40%60%PAWPCOSVRRAP预测准确性EisenbergPR,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-553临床判断缺乏准确性临床判断缺乏准确性:PAWP:PAWP01015191915100预计PAWP(mmHg)测定PAWP(mmHg)EisenbergPL,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-553NochangeinplannedtherapyaftercatheterizationChangeinplannedtherapyaftercatheterization0临床判断缺乏准确性临床判断缺乏准确性:CO:CO04.57.0预计CO(L/min)测定CO(L/min)EisenbergPL,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-5534.57.0临床判断缺乏准确性临床判断缺乏准确性EisenbergPL,JaffeAS,SchusterDP.Clinicalevaluationcomparedtopulmonaryarterycatheterizationinthehemodynamicassessmentofcriticallyillpatients.CritCareMed1984;12(7):549-553参数参数判断正确数目判断正确数目//测定数目测定数目正确率正确率(%)(%)PAWPPAWP31/10231/1023030COCO49/9749/975151SVRSVR39/8839/884444RAPRAP54/9854/985555ICUICU患者的输液治疗的决定因素患者的输液治疗的决定因素临床经验临床经验中心静脉压中心静脉压(CVP)(CVP)肺动脉楔压肺动脉楔压(PAWP)(PAWP)BoldtJ,LenzM,KumleB,PapsdorfM.Volumereplacementstrategiesonintensivecareunits:resultsfromapostalsurvey.IntensiveCareMed1998;24:147-151压力有时不能代表前负荷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）CVP/PAWPCVP/PAWP不能预测扩容反应不能预测扩容反应Lichtwarck-Aschoffetal,IntensiveCareMed1992;18:142-147何去何从何去何从PICCOPICCO技术技术CentralvenouscatheterInjectatetemperatureInjectatetemperaturesensorhousingsensorhousingPV4046PV4046ArterialthermodilutioncatheterInjectatetemperaturesensorcablePC80109PULSIONdisposablepressuretransducerPV8115PCCIAP13.0316.28TB37.0AP14011792(CVP)5SVRI2762PCCI3.24HR78SVI42SVV5%dPmx1140(GEDI)625DPTMonitorcablePMK-206InterfacecablePC80150ConnectioncabletobedsidemonitorPMK-XXXAUXada...
