ICG技术和临床运用：培训.ppt

* ICG data have also been shown to have prognostic value in heart failure patients. The PREDICT study was a major study conducted in the U.S. at 22 heart failure centers. 212 patients participated in this study and were evaluated and treated every two weeks for 26 weeks by heart failure specialists. At the end of the evaluation period, some of the patients had had heart failure events and some did not. The patient’s records were thoroughly evaluated to determine which, if any, parameters predicted future heart failure events. The most powerful predictor of future heart failure events was an ICG score. This score was based on three ICG Parameters: TFC Index, VI, and LVET. Patients with the highest quartile ICG scores were 8.29 times higher risk of having a heart failure event in the 14 days following the clinic visit than those with the lowest quartile score. Unfortunately, the GE ICG Module does not provide this ICG Score. However, it does provide SI and TFC which were also shown to effectively identify patients at higher risks of heart failure events 14, 30, 60, and 90 days following a clinic visit. The results of the PREDICT study are very meaningful and deserve additional comments. * These 4 Quadrants are reminiscent of Dr. Lynne Warner Stevenson’s characterization of HF into Hemodynamic Subsets, based on perfusion (in this case reflected by Stroke Index) and congestion (reflected by TFC). * * * * * * * * * 重症医学科ICU的临床应用 全麻后复苏患者的血流动力学监测 行机械通气患者的血流动力学监测 多发伤患者早期液体复苏中的血流动力学监测 控制液体量及输液速度 急性呼吸困难患者的鉴别诊断 急性心力衰竭患者的血流动力学监测 心输出量 CO/CI 心率 HR 前负荷 TFC 每搏输出量 SV/SI 后负荷 SVR/SVRI 心肌收缩力 VI/STR β-受体阻滞剂 ↓ ↓ ↓ ↑ ↑ ↑ ↓ 利尿剂 硝酸甘油 醛固酮拮抗剂 ACEI,ARB 肼屈嗪 其他血管扩张剂 β-受体阻滞剂 短期内β-受体阻滞剂剂量可能应下降，长期可能上升 强心苷类药物 心力衰竭病人通常表现为心输出量CO/CI和每搏射血量SV/SI降低，伴随前负荷增加，心肌收缩力减弱（与心动过速相关），和/或后负荷增加 血液动力学治疗包括给利尿剂以降低血容量，扩血管药以降低后负荷 氧运输量：DO2＝Hgb*SaO2*CO*1.36 心衰：血流动力学状态和药物治疗 Prospective Evaluation and Identification of Cardiac Decompensation in Patients with Heart Failure by Impedance Cardiography Test (PREDI