CVP与扩容-中国心胸血管麻醉学会.PDF

心血管外科手术后容量管理 国家心血管病中心 中国医学科学院阜外医院 SICU 陈祖君 1 Contents Adequate fluid and volume supply is of major importance to 1 prevent development of organ damage in cardiac surgery patients But overload fluid also Increases the Incidence of 2 Post Operative Complications 3 Fluid is a DRUG should be used carefully 2 The Arteries Blood Volume (血容量) 1. Heart: 7% 2. Systematic Circulation (体循环): 84% 1) Arteries: 15% 2) Capillaries: 5% 3) Veins: 64% 3. Pulmonary Circulation (肺循环): 9% Blood Vessels (血管): 97000 km 3 overload fluid 4 Fluid load vs Complications 5 Fluid overload in cardiac surgery patients 6 Although correct the fluid overload after cardiac surgery, the patients still have higher 90 day mortality 7 心外科术后液体过负荷的危害 8 病人选择 9 肌酐与ICU住院时间 Fluid overload increase the cteatinine and the length of ICU stay 10 Challenge  How to assess the fluid state  Predict fluid responsivity Avoid overload fluid 11 The essence of fluid resuscitation 12 Indicator for fluid challenge  Cardiac filling pressure:CVPPAWP  Cardiac volume parameter :GEDI(picco),LVEDI(ec