PiCCO技术简介和临床价值.ppt

PiCCO plus 容量监护仪 正确的监测才能进行正确的治疗 循环状态如何？ 心脏前负荷是否足以获得充分的心输出量，这与病人的临床状况是否相符和？ 病人是否需要补充液体还是减少液体？ 是否可以停止、缩短或避免机械通气？ 心脏功能如何？是否需要给予心肌收缩或血管活性药物？ 后负荷如何？ PiCCO技术参数能回答以下问题： 心血管状况如何？ 心输出量 （CO） 前负荷如何？ 全心舒张末期容积 (GEDV) 扩容治疗会增加心输出量吗？ 每搏量变异 (SVV) 心脏收缩功能如何？ 左室最大收缩力指数(dpmax) 全心射血分数 (GEF) 是否会发生或是已经出现了肺水肿？ 血管外肺水（EVLW） 什么是PiCCO？ PiCCO是一种技术，是一种简便、微创、高效费比的，对重症病人主要血流动力学参数进行监测的工具。 PiCCO的连接？ PiCCO监测参数的临床意义 PiCCO的临床价值 PiCCO技术参数能回答以下问题： 心血管状况如何？ 前负荷如何？ 扩容治疗会增加心输出量吗？ 心脏收缩功能如何？ 是否会发生或是已经出现了肺水肿？ Measurement of CO on its own does not allow the location on the Frank-Starling curve to be determined. In order to estimate the area where the individual patient‘s heart is located, the preload must be measured. What parameters are available for measuring the preload? - classical parameters: cardiac filling pressures CVP (via CVC) and PCWP (via pulmonary arterial catheter) - static volumetric preload parameters: GEDV (global end-diastolic volume and ITBV (intrathoracic blood volume) - dynamic parameters SVV (stroke volume variation) and PPV (pulse pressure variation). In the narrower sense, these are not preload parameters but parameters of the heart‘s preload responsiveness (reaction of cardiac stroke volume to volume administration) The relevance of the filling pressures for assessing cardiac preload has long been disputed and has been refuted in numerous publications. Neither the absolute level of the CVP (shown on left) nor the changes in CVP (shown on right) correlate with stroke volume. CVP therefore not suitable for assessing volume status. The pulmonary capillary wedge pressure (PCWP) and alterations of this do not show any correlation with cardiac ejection either. Thus measurement of cardiac preload is not possible by means of the traditionally employed PCWP either. FACCT study by the ARDS Networks, published in the New England Journal of Medicine: no difference in the outcome of ARDS patients with CVP-guided fluid management and those wi