PICCO(护理讲课).ppt

Representation of the association between cardiac preload (ventricular end-diastolic filling volume) and stroke volume: up to a certain limit, the stroke volume increases with increasing preload (area of volume responsiveness). The optimal filling volume is reached when a further increase of the preload leads to no further or only a slight increase in stroke volume (target area). If there is a further increase in preload beyond this point, there is then a fall in the stroke volume as the cardiac muscle is over-stretched and so loses some of its contractility (volume overload). This curve can demonstrate different slopes and different areas for volume responsiveness and volume overload depending on the contractility of the ventricle. 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. 关于动脉导管的特异性，因为picco技术需要精确的计算，这项专利属于pulsion公司，他们提供的动脉导管是专为这项技术儿设计 但是有研究在不同部位放置picco导管 和 漂浮导管 测量CO做比较显示，不同位置放置picco动脉导管都能准确反映心输出量，但是研究同样显示导管放置需靠近大主动脉以获得准确数值，所以我们在临床帮助医生第一次使用导管的时候，必须要强调，导管放到位，不能后拉 还有娆动脉是不鼓励放置导管的，因为所测得的压力波形很容易收到干扰 如果要看趋势没有问题， The risks include the usual risks of puncturing arteries or central veins. Since intensive care patients usually require these vascular accesses anyway, use of PiCCO does not involve any additional risk. In general,