ICU血流动力学监测和PICCO技术课件.ppt

1、Boldt J, Lenz M, Kumle B, Papsdorf M. Volume replacement strategies on intensive care units: results from a postal survey. Intensive Care Med 1998; 24: 147-151Boldt J, Lenz M, Kumle B, Papsdorf M. Volume replacement strategies on intensive care units: results from a postal survey. Intensive Care Med

2、 1998; 24: 147-151Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery ca

3、theterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-55301015191915100预计预计PAWP (mmHg)测定测定PAWP (mmHg)Eisenberg PL, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill

4、patients. Crit Care Med 1984; 12(7): 549-553No change in planned therapy after catheterizationChange in planned therapy after catheterization004.57.0预计预计CO (L/min)测定测定CO (L/min)Eisenberg PL, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic as

5、sessment of critically ill patients. Crit Care Med 1984; 12(7): 549-5534.57.0Eisenberg PL, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553Boldt J, Lenz M, Kumle B, Pap

6、sdorf M. Volume replacement strategies on intensive care units: results from a postal survey. Intensive Care Med 1998; 24: 147-151左室左室舒张末容积（舒张末容积（LVEDVLVEDV，真实的左室前负荷），真实的左室前负荷） 肺动脉阻塞压（肺动脉阻塞压（PAOPPAOP） Lichtwarck-Aschoff et al, Intensive Care Med 1992; 18: 142-147Central venous catheterArterial therm

7、odilution catheter Injectate temperature sensor cablePC80109 PULSION disposable pressure transducer PV8115PCCIAP13.03 16.28 TB37.0AP 140117 92(CVP) 5SVRI 2762PCCI 3.24HR 78SVI 42SVV 5%dPmx 1140(GEDI) 625 DPT Monitor cablePMK-206Interface cablePC80150 Connection cableto bedside monitorPMK - XXX AUX a

8、daptercable PC81200 a. 经肺热稀释技术经肺热稀释技术b. 动脉脉搏轮廓分析技术动脉脉搏轮廓分析技术ln c (I)注射注射At再循环再循环MTtte-1DStc (I) Lichtwarck-Aschoff et al, Intensive Care Med 1992; 18: 142-147Goedje et al, Eur J Cardiothorac Surg 1998; 13 (5): 533-539;discussion 539-540ParameterRangeUnit心心指数（指数（CI）3.0 5.0l/min/m2每搏量每搏量指数（指数（SVI）40 6

9、0ml/m2 全身血管阻力（全身血管阻力（SVRI）1200 1800dyn*s*cm-5*m平均动脉压（平均动脉压（MAP）70 90mmHg全心射血全心射血分数（分数（GEF）25 35%心心功能指数（功能指数（CFI）4.5 6.51/min心心率（率（HR）60 901/min舒张末期容积指数（舒张末期容积指数（GEDI）680 800ml/m2胸腔血容积指数（胸腔血容积指数（ITBI）850 1000ml/m2每搏每搏量变异（量变异（SVV） 10%血管外肺水指数（血管外肺水指数（EVLWI） 3.0 7.0ml/kg肺肺血管通透指数（血管通透指数（PVPI）1.0 3.0CI (l

10、/min/m2)ITBVI (ml/m2)TherapyTargetITBVICFIEVLWI (slowly responding) 4.5 10 V+! Cattemporary750-8505.5104.53.010 Cat V-temporary750-850 5.5 1010 V+850-100010 V+temporary750-850850850 10 V-temporary750-850 10850EVLWI (ml/kg)V+ = volume loading (! = cautiously)V- = volume contractionCat = catecholamine

11、s/ cardiovascular agents 74岁女性，发生车祸岁女性，发生车祸1小时后被送入急诊小时后被送入急诊 检查发现病人有颌面部骨折，头部外伤，检查发现病人有颌面部骨折，头部外伤，伴有少量蛛网膜下腔出血伴有少量蛛网膜下腔出血 （GCS评分评分3），双），双侧胸部挫伤侧胸部挫伤 腹部超声检查未发现积液腹部超声检查未发现积液超声检查 = 心脏功能良好，左心室舒张末期容积（LVEDV）足够此时已经补液 3487 ml低血容量?心脏挫伤?心肌梗死?肺栓塞?高位脊髓损伤?为什么她会出现低血压为什么她会出现低血压?鉴于患者一般状态尚好，在股动脉内插入了一条PiCCO导管（病人已经放置了一条中心静脉导管），结果大量给液大量给液CO升高升高新鲜冻血浆新鲜冻血浆之前补液之前补液血代血代Hartmann液液补液后补液后 SVV（每搏量变异）下降（每搏量变异）下降 病人生命体征正常时，也有存在低CO的可能 低胸腔内血容积指数（ITBVi）和高每搏量变异（ SVV）可靠地说明前负荷低