关注危重病人液体平衡(定稿).pptxVIP

关注危重病人液体平衡;目录;;EarlyGoal-DirectedTherapyintheTreatmentofSevereSepsisandSepticShock

;;CVP:centralvenouspressure

MAP:meanarterialpressure

ScvO2:centralvenousoxygensaturation;第七页，共六十一页。;第八页，共六十一页。;;质疑点;CVP监测能准确指导液体复苏吗？;Objective:Asystematicreviewoftheliteraturetodeterminethefollowing:

therelationshipbetweenCVPandbloodvolume,

theabilityofCVPtopredictfluidresponsiveness,

theabilityofthechangeinCVP(CVP)topredictfluidresponsiveness.;Thepooledcorrelationcoefficientbetweenthe

CVPandmeasuredbloodvolumewas0.16(95%CI,

0.03to0.28;r=0.02).;1、ThepooledcorrelationcoefficientbetweenbaselineCVPandchangeinstrokeindex/cardiacindexwas0.18

2、ThepooledareaundertheROCcurvewas0.56

3、ThepooledcorrelationbetweenCVPandchangeinstrokeindex/cardiacindexwas0.11

4、ThebaselineCVPwas8.7-2.3mmHgintheresponders,ascomparedto9.7-2.2mmHginnonresponders(notsignficant;p0.3).;结论;FluidResuscitationinSepticshock

APositiveFluidBalanceandElevatedCentralVenousPressureAreAssociatedWithIncreasedMortality

;12h液体平衡与CVP有关联，24小时就没有关联;CVPGroup;Stopfillingpatientsagainstcentralvenouspressure,please!*;LeesN,HamiltonM,RhodesA:Clinicalreview:

Goal-directedtherapyinhighrisksurgical

patients.CritCare2022;13:231;修正的EGDT试验

1.镇静镇痛

2.液体反响性：CVP动态变化；对于正压通气患者SVV/PPV

3.滴定MAP75~85mmHg

4.P(cv-a)CO2

5.血管活性药撤离试验;血管活性药物撤离试验;液体超负荷，我们要重视的问题！;PayenS,etal,fortheSepsisOccurrenceinAcutelyIllPatients(SOAP)Investigators:Apositivefluidbalanceisassociatedwithaworseoutcomeinpatientswithacuterenalfailure.CritCare12:R74,2022;FluidResuscitationinSepticshock

APositiveFluidBalanceandElevatedCentralVenousPressureAreAssociatedWithIncreasedMortality

;12h液体正平衡4.2±3.8L

第四天液体正平衡11±8.9L;;1、2与4相比，死亡率下降

3与4相比，有下降，但无统计学意义;CVPGroup;VincentJL,etal:SepsisinEuropeanintensivecareunits:resultsoftheSOAPstudy.CritCareMed2006;