PiCCO监测__培训课件.ppt

* Brief presentation of another parameter that is not a preload parameter but is nevertheless highly important for guiding volume management: Extravascular lung water signifies the water content of the lungs outside the blood vessels. The EVLW therefore consists of the interstitial, intracellular and intraalveolar water of lung tissue. Pulmonary oedema can be diagnosed with certainty and its severity determined with the extravascular lung water. The parameter can be measured at the bedside using thermodilution, in contrast to conventional methods such as chest X-ray. The level of lung water and changes in this can provide important information for guiding volume therapy, as the point of time from which volume therapy leads to the development of pulmonary oedema can be identified. * 有研究显示，肺水增长要超过一倍才能被胸片所反映，而且胸片经常会收到胸腔膜积液的影响以及床边拍摄的技术限制 与此同时，血管外肺水和肺水肿呈线性关系 病人的预后情况和肺水肿有直接的关系，当血管外肺水大于正常范围以后，死亡率会随之上升超过70％ The optimum approach to fluid therapy is based on adequate interpretation of several physiologic parameters. EVLW gives unique and crucial information about lung fluid accumulation that can not be obtained in any other way. X-ray of the lung is also often difficult to interpret, especially in the supine patient. Pulmonary shadowing is not the same as pulmonary oedema (right) but can also be due e.g. to a pleural effusion. Conversely, severe pulmonary oedema can be present (top left) without this being particularly obvious on the X-ray. As the pictures on the left show, the degree of radiographic shadowing does not correlate with the severity of the pulmonary oedema. * 有研究显示，肺水增长要超过一倍才能被胸片所反映，而且胸片经常会收到胸腔膜积液的影响以及床边拍摄的技术限制 与此同时，血管外肺水和肺水肿呈线性关系 病人的预后情况和肺水肿有直接的关系，当血管外肺水大于正常范围以后，死亡率会随之上升超过70％ The optimum approach to fluid therapy is based on adequate interpretation of several physiologic parameters. EVLW gives unique and crucial information about lung fluid accumulation that can not be obtained in any other way. * 肺血管通透性指数（PVPI）是血管外肺水和肺血容量的比值，通过PVPI可以分辨肺水肿的类型，提示了肺