血流动力学监测-PICCO-杜斌PPT.ppt

CVP/PAWP不能预测扩容反应 Lichtwarck-Aschoff et al, Intensive Care Med 1992; 18: 142-147 ITBV能够更好地反映前负荷 Lichtwarck-Aschoff et al, Intensive Care Med 1992; 18: 142-147 预测扩容反应: PAWP/CVP vs. ITBV 1. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL. Relation between Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness in Septic Patients with Acute Circulatory Failure. Am J Respir Crit Care Med 2000; 162: 134-138. 2. Rex S, Brose S, Metzelder S, Huneke R, Schalte G, Autschbach R, Rossaint R, Buhre W. Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth 2004; 93: 782-788 前负荷指标与?SV / ?CI的相关性 所有患者 单一患者 相关系数, r ?SVIart ?CIart ?CIart (最低值 – 最高值) ?CVP -0.09 0.00 -0.01 – 0.33 ?PAWP -0.02 -0.01 -0.36 – 0.03 ?RAEDVI 0.28 -0.11 -0.02 – 0.37 ?RVEDVI 0.03 -0.02 0.02 – 0.03 ?ITBVI 0.76 0.83 0.67 – 0.91 ?GEDVI 0.82 0.87 0.70 – 0.93 Goedje et al, Eur J Cardiothorac Surg 1998; 13 (5): 533-539;discussion 539-540 心输出量和全身循环阻力 由于脉搏轮廓分析连续测量每搏量和动脉压, 可以如下计算得到心输出量(CO)和全身循环阻力(SVR): CO = 每搏量 x 心率 SVR = (平均动脉压 – 中心静脉压) / CO 每搏量变异(SVV) 对于没有心律失常的机械通气患者 SVV反映了心脏对因机械通气导致的心脏前负荷周期性变化的敏感性 SVV可以用于预测扩容治疗是否会使每搏量增加 SVmax SVmin SVmean SVmax – SVmin SVV (30秒) = SVmean 对扩容反应的预测性: CVP vs. SVV Sensitivity 1 – Specificity Berkenstadt et al, Anesth Analg 2001; 92: 984-989 - - - CVP __ SVV 血管外肺水的测定: EVLW 放射影像学(radiology) 指示剂稀释技术(indicator dilution technique) 显像技术(imaging technique) 重力测定技术(gravimetric technique) 氧合与肺水肿 静水压升高引起肺水肿 CMV FiO2 0.4 Scillia P, Delcroix M, Lejeune P, Melot C, Struyven J, Naeije R, Gevenois PA. Hydrostatic pulmonary edema: evaluation with thin-section CT in dogs. Radiology 1999; 211: 161-168 血管外肺水与氧合 Martin GS, Eaton S, Mealer M, Moss M. Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care 2005; 9: R74-R82 (DOI 10.1186/cc3025) 血管外肺水与病死率 Sturm, In: Practical Applications of Fiberoptics in Critical Care Monitoring, Springer Verlag Berlin - Heidelberg -