《icco的临床应用》PPT课件

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1、血流动力学监测Theory and Practice 血流动力学 Swan和Ganz发明通过血流引导的气囊漂浮导管（漂浮导管 或 Swan-Ganz 导管 或 肺动脉导管）继中心静脉压（CVP）之后临床监测的一大新进展 Dr. William Ganz (1919-2009.11.10) Swan-Ganz 导管 通过热稀释法获得心排 假设 PCWP(肺毛细血管嵌压) LAP（左房压） LVEDP(左室舒张末压) LVEDV(左室舒张末容量) 相 当于前负荷来通过压力指标来反映容量状态 经食管超声技术（TEE） 原理物体（红细胞）移动的速度和已知频率超声波的反射频率成正比 HemoSonicT

2、M100的超声多普勒探头 通过测定红细胞移动的速度来推算降主动脉的血流量 TEE优势： 准确性高 降主动脉的血流量是CO的70% 劣势： 误差多，对操作者经验要求高，需严格培训，费用高 7 监测生命体征MonitoringRespiration RateTemperature 8 一些重要的指标Monitoring Blood Pressure (NiBP) no correlation with CO no correlation with oxygen deliveryECGRespiration RateTemperature PiCCO Technology液体管理所需要的指标Intr

3、oduction to the PiCCO-TechnologyCO前负荷 EVLW收缩力指数个性化的容量管理- static - dynamic PiCCO 技术监测1.功能原理2.热稀释技术3.脉搏轮廓分析技术4.收缩力指数5.前、后负荷参数6.血管外肺水7.肺部通透性指数血流动力学监测 PiCCO 技术 依据经肺热稀释技术以及脉搏轮廓分析技术原理 Left HeartRight HeartPulmonary CirculationLungsBody CirculationPULSIOCATHPULSIOCATHCVC PULSIOCATH arterial thermodilution

4、cathetercentral venous bolus injection Introduction to the PiCCO-Technology Function Bolus injection concentration changes over time(Thermodilution curve)中心静脉处注入冰盐水，依次经过胸腔内各腔室 股动脉导管内有热敏电阻，会记录温度的变化 Introduction to the PiCCO-Technology Function Left heartRight heart LungsRA RV LA LVPBVEVLWEVLW原理 胸腔内各腔

5、室Introduction to the PiCCO-Technology Function肺内热容积 (PTV)胸腔内热容积 (ITTV) Total of mixing chambers RA RV LA LVPBVEVLWEVLW最大混合腔室 血流动力学监测Introduction to PiCCO Technology1.功能原理2.热稀释技术3.脉搏轮廓分析技术4.收缩力指数5.后负荷参数6.血管外肺水7.肺部通透性指数 Tb x dt(Tb - Ti) x Vi x K Tb Injection t D=COTD aTb = Blood temperatureTi = Inject

6、ate temperatureVi = Injectate volume Tb . dt = Area under the thermodilution curveK = Correction constant, made up of specific weight and specific heat of blood and injectateCO的计算是通过对热稀释曲线分析， 使用 Stewart-Hamilton 方程式 心排的计算Introduction to the PiCCO-Technology Thermodilution 热稀释曲线下面积反比例反映CO 36,537 5 10

7、 热稀释曲线Normal CO: 5.5l/minIntroduction to the PiCCO-Technology Thermodilution 36,53736,537 Timelow CO: 1.9l/minHigh CO: 19l/minTimeTimeTemperatureTemperatureTemperature 经肺热稀释 vs. 肺动脉导管 Left heartRight HeartPulmonary Circulation LungsBody Circulation PULSIOCATH arterial thermo-dilution cathetercentral

8、 venous bolus injection RA RV PALALVAorta Transpulmonary TD (PiCCO) Pulmonary Artery TD (PAC)In both procedures only part of the injected indicator passes the thermistor.Nonetheless the determination of CO is correct, as it is not the amount of the detected indicator but the difference in temperatur

9、e over time that is relevant! Introduction to the PiCCO Technology Thermodilution Comparison with the Fick Method 0,970,68 0,6237/449Sakka SG et al., Intensive Care Med 25, 1999 - / - 0,19 0,219/27McLuckie A. et a., Acta Paediatr 85, 1996 0,960,16 0,3130/150Gdje O et al., Chest 113 (4), 1998 0.980,3

10、2 0,2923/218Holm C et al., Burns 27, 2001 0,930,13 0,5260/180Della Rocca G et al., Eur J Anaest 14, 2002 0,95-0,04 0,4117/102Friedman Z et al., Eur J Anaest, 2002 0,950,49 0,4545/283Bindels AJGH et al., Crit Care 4, 2000 0,980,03 0,1718/54Pauli C. et al., Intensive Care Med 28, 2002 24/120n (Pts / M

11、easurements) 0,990,03 0,24Tibby S. et al., Intensive Care Med 23, 1997 r bias SD(l/min)Comparison with Pulmonary Artery Thermodilution经肺热稀释技术的有效性 Introduction to the PiCCO Technology Thermodilution MTt: Mean Transit time the mean time required for the indicator to reach the detection pointDSt: Down

12、Slope time the exponential downslope time of the thermodilution curveRecirculation te-1TbFrom the characteristics of the thermodilution curve it is possible to determine certain time parameters 对热稀释曲线做进一步分析 Introduction to the PiCCO-Technology ThermodilutionInjectionIn Tb MTt DSt Tb = blood temperat

13、ure; lnTb = logarithmic blood temperature; t = time Pulmonary Thermal VolumePTV = Dst x CO By using the time parameters from the thermodilution curve and the CO ITTV and PTV can be calculated 计算 ITTV 与 PTVIntroduction to the PiCCO-Technology Thermodilution Recirculation te -1Tb InjectionIn TbIntrath

14、oracic Thermal VolumeITTV = MTt x COMTt DSt Pulmonary Thermal Volume (PTV)Intrathoracic Thermal Volume (ITTV)Calculation of ITTV and PTVEinfhrung in die PiCCO-Technologie ThermodilutionITTV = MTt x COPTV = Dst x CO RA RV LA LVPBVEVLWEVLW GEDV is the difference between intrathoracic and pulmonary the

15、rmal volumesGlobal End-diastolic Volume (GEDV) Volumetric preload parameters GEDVRA RV LA LVPBVEVLW EVLW ITTVGEDVPTV Introduction to the PiCCO Technology Thermodilution Volumetric preload parameters ITBVIntrathoracic Blood Volume (ITBV)GEDVITBVPBVRA RV LA LVPBVEVLW EVLW Introduction to the PiCCO Tec

16、hnology Thermodilution ITBV is the total of the Global End-Diastolic Volume and the blood volume in the pulmonary vessels (PBV) ITBVTD (ml) ITBV = 1.25 * GEDV 28.4 ml GEDV vs. ITBV in 57 Intensive Care Patients Introduction to the PiCCO-Technology ThermodilutionITBV is calculated from the GEDV by th

17、e PiCCO Technology 0100020003000 0 1000 2000 3000 GEDV (ml)Sakka et al, Intensive Care Med 26: 180-187, 2000 Summary and Key Points - Thermodilution PiCCO 技术是一种微创的方法，用以监测容量状态和心血管功能 根据经肺热稀释技术可以计算出各种容积参数. CO 由热稀释曲线形状描记. 心脏前负荷相关的容积参数可以通过对热稀释曲线进一步分析获得。 Introduction to the PiCCO-Technology Haemodynamic M

18、onitoringIntroduction to PiCCO Technology1.功能原理2.热稀释技术3.脉搏轮廓分析技术4.收缩力指数5.后负荷参数6.血管外肺水7.肺部通透性指数 Transpulmonary ThermodilutionThe pulse contour analysis is calibrated through the transpulmonary thermodilution and is a beat to beat real time analysis of the arterial pressure curveCalibration of the Pul

19、se Contour AnalysisIntroduction to the PiCCO-Technology Pulse contour analysisInjection Pulse Contour Analysis T = blood temperature t = timeP = blood pressure PCCO = cal HR P(t)SVR + C(p) dPdt( ) dtCardiac OutputPatient- specific calibration factor (determined by thermodilution) Heart rate Area und

20、er the pressure curve Shape of the pressure curveAortic complianceSystoleIntroduction to the PiCCO-Technology Pulse contour analysisParameters of Pulse Contour Analysis n (Pts / Measurements) 0,940,03 0,6312 / 36Buhre W et al., J Cardiothorac Vasc Anesth 13 (4), 1999 19 / 7624 / 51762 / 18620 / 3602

21、5 / 380 22 / 96 - / -0,40 1,3Mielck et al., J Cardiothorac Vasc Anesth 17 (2), 2003 0,880,31 1,25Zllner C et al., J Cardiothorac Vasc Anesth 14 (2), 2000 0,88-0,2 1,15Gdje O et al., Crit Care Med 30 (1), 2002 0,94-0,02 0,74Della Rocca G et al., Br J Anaesth 88 (3), 2002 0,93-0,14 0,33Felbinger TW et

22、 al., J Clin Anesth 46, 2002 - / - 0,14 0,58Rauch H et al., Acta Anaesth Scand 46, 2002 r bias SD (l/min)Comparison with pulmonary artery thermodilutionValidation of Pulse Contour AnalysisIntroduction to the PiCCO-Technology Pulse contour analysis The Stroke Volume Variation is the variation in stro

23、ke volume over the ventilatory cycle, measured over the previous 30 second period. Parameters of Pulse Contour AnalysisIntroduction to the PiCCO-Technology Pulse Contour AnalysisDynamic parameters of volume responsiveness Stroke Volume Variation The increase of preload volume is equal: EDV1 = EDV2 S

24、V1 SV2SVV 提示心脏对容量治疗的反应好坏EDVSV SVV smallSVV large EDV1 EDV2 SV1 SV2 The pulse pressure variation is the variation in pulse pressure over the ventilatory cycle, measured over the previous 30 second period. Parameters of Pulse Contour AnalysisIntroduction to the PiCCO-Technology Pulse Contour AnalysisD

25、ynamic parameters of volume responsiveness Pulse Pressure Variation Summary pulse contour analysis - CO and volume responsiveness PiCCO脉搏轮廓分析技术是由经肺热稀释技术计算进一步获得 PiCCO 技术分析动脉压力曲线每次的搏动，可以提供实时的参数 CO之外， 反映容积相关的血流动力学参数SVV (stroke volume variation) 和PPV (pulse pressure variation) 可以持续获得Introduction to the

26、PiCCO-Technology Pulse contour analysis Haemodynamic MonitoringIntroduction to PiCCO Technology1.功能原理2.热稀释技术3.脉搏轮廓分析技术4.收缩力指数5.后负荷参数6.血管外肺水7.肺部通透性指数 Contractility is a measure for the performance of the heart muscle Contractility parameters of PiCCO technology:- dPmx (maximum rate of the increase in

27、 pressure)- GEF (Global Ejection Fraction)- CFI (Cardiac Function Index)Contractility Introduction to the PiCCO-Technology Contractility parameterskg Contractility parameter from the pulse contour analysisIntroduction to the PiCCO-Technology Contractility parametersdPmx = maximum velocity of pressur

28、e increase The contractility parameter dPmx represents the maximum velocity of left ventricular pressure increase. Contractility parameter from the pulse contour analysisIntroduction to the PiCCO-Technology Contractility parametersfemoral dP/max mmHg/s LV dP/dtmax mmHg/sdPmx was shown to correlate w

29、ell with direct measurement of velocity of left ventricular pressure increase in 70 cardiac surgery patients de Hert et al., JCardioThor&VascAnes 2006 n = 220y = -120 + (0,8* x)r = 0,82p 0,001050010001500 0 1000 15002000 2000500dPmx = maximum velocity of pressure increase is calculated as 4 times th

30、e stroke volume divided by the global end-diastolic volume reflects both left and right ventricular contractilityGEF = Global Ejection Fraction Contractility parameters from the thermodilution measurementIntroduction to the PiCCO-Technology Contractility parameters 4 x SVGEF = GEDVLA LVRA RV Combes

31、et al, Intensive Care Med 30, 2004 GEF = Global Ejection Fraction Comparison of the GEF with the gold standard TEE measured contractility in patients without right heart failuresensitivity 00,40,60,8 01 0,20,2 0,4 0,6 0,81 specifity22 2019 18 16 12 8 D FAC, %D GEF, %510-5-20 -10 10 2015-15-10 r=076,

32、 p0,0001n=47 Introduction to the PiCCO-Technology Contractility parametersContractility parameters from the thermodilution measurement is the CI divided by global end-diastolic volume index is - similar to the GEF a parameter of both left and right ventricular contractilityCFI = Cardiac Function Ind

33、ex CICFI = GEDVIIntroduction to the PiCCO-Technology Contractility parametersContractility parameters from the thermodilution measurement Combes et al, Intensive Care Med 30, 2004 sensitivity 00,40,60,8 0 1 0,20,2 0,4 0,6 0,8 1 specificity6 5 4 3,5 3 2 D FAC, % D GEF, %510-5-20 -10 10 20 15 -15-10 r

34、=079, p0,0001n=47 CFI = Cardiac Function IndexIntroduction to the PiCCO-Technology Contractility parametersCFI was compared to the gold standard TEE measured contractility in patients without right heart failure Contractility parameters from the thermodilution measurement Haemodynamic MonitoringIntr

35、oduction to PiCCO technology1.功能原理2.热稀释技术3.脉搏轮廓分析技术4.收缩力指数5.后负荷参数6.血管外肺水7.肺部通透性 is calculated as the difference between MAP and CVP divided by CO as an afterload parameter it represents a further determinant of the cardiovascular situation is an important parameter for controlling volume and catecho

36、lamine therapies(MAP CVP) x 80SVR = COAfterload parameterSVR = Systemic Vascular ResistanceMAP = Mean Arterial PressureCVP = Central Venous PressureCO = Cardiac Output80 = Factor for correction of unitsIntroduction to the PiCCO Technology Afterload parameter 收缩力指数 dPmx 由脉搏轮廓分析技术获得， 用于评估左室心肌功能， 给出了心功

37、能重要的信息， 可以指导治疗 收缩力指数 GEF 和 CFI 是评估全心功能的重要参数 ，支持心衰的早期诊断 外周血管阻力 SVR 由血压和心排获得，是一个进一步评估心血管功能的指数， 对于容量的控制和血管活性药物的应用提供了重要信息。Summary and Key PointsIntroduction to the PiCCO Technology Contractility and Afterload Haemodynamic MonitoringIntroduction to PiCCO technology1.功能原理2.热稀释技术3.脉搏轮廓分析技术4.收缩力指数5.后负荷参数6.血

38、管外肺水7.肺部通透性指数 To Dry or Not to Dry ITTV ITBV= EVLWThe Extravascular Lung Water is the difference between the intrathoracic thermal volume and the intrathoracic blood volume. It represents the amount of water in the lungs outside the blood vessels.Calculation of Extravascular Lung Water (EVLW)Introdu

39、ction to the PiCCO Technology Extravascular Lung Water 容量测量小结ITTV = CO * MTtTDaPTV = CO * DStTDaITBV = 1.25 * GEDVEVLW = ITTV - ITBVGEDV = ITTV - PTV RAEDV RVEDV LAEDV LVEDVRAEDV RVEDV LAEDV LVEDVPBVRAEDV RVEDV LAEDV LVEDVPTVPTVEVLW EVLW Katzenelson et al,Crit Care Med 32 (7), 2004 Sakka et al, Inte

40、nsive Care Med 26: 180-187, 2000 Gravimetry Dye dilutionEVLW from the PiCCO technology has been shown to have a good correlation with the measurement of extravascular lung water via the gravimetry and dye dilution reference methodsValidation of Extravascular Lung Water n = 209r = 0.96ELWI by gravime

41、tryELWI by PiCCO R = 0,97P 0.05 02080 15-10-15 1060D radiographic score-80-60-40-20 D ELWIEVLW as a quantifier of lung oedema Introduction to the PiCCO Technology Extravascular Lung Water ELWI (ml/kg) 21 n = 5414 - 21 n = 1007 - 14 n = 174 2090100 Sakka et al , Chest 2002 Introduction to the PiCCO T

42、echnology Extravascular Lung Water Intensive Care days Mitchell et al, Am Rev Resp Dis 145: 990-998, 1992 Relevance of EVLW AssessmentVolume management guided by EVLW can significantly reduce time on ventilation and ICU length of stay in critically ill patients, when compared to PCWP oriented therap

43、y, Ventilation Days PAC Groupn = 101 * p 0,05 PAC GroupEVLW Group EVLW Group22 days 15 days9 days 7 days* p 0,05 Introduction to the PiCCO Technology Extravascular Lung Water Haemodynamic MonitoringIntroduction to PiCCO Technology1.功能原理2.热稀释技术3.脉搏轮廓分析技术4.收缩力指数5.后负荷参数6.血管外肺水7.肺部通透性指数 Differentiating

44、Lung OedemaPVPI = Pulmonary Vascular Permeability Index is the ratio of Extravascular Lung Water to Pulmonary Blood Volume is a measure of the permeability of the lung vessels and as such can classify the type of lung oedema (hydrostatic vs. permeability caused)EVLWPVPI = PBV PBVEVLWIntroduction to

45、PiCCO Technology Pulmonary Permeability permeabilityPVPI normal (1-3) PVPI raised (3)Classification of Lung Oedema with the PVPIDifference between the PVPI with hydrostatic and permeability lung oedema:Lung oedemahydrostaticPBVEVLW PBVEVLWPBVEVLW PBVEVLWIntroduction to PiCCO Technology Pulmonary Per

46、meability 16 patients with congestive heart failure and acquired pneumonia. In both groups EVLW was 16 ml/kg. Validation of the PVPIPVPI can differentiate between a pneumonia caused and a cardiac failure caused lung oedema. Benedikz et al ESICM 2003, Abstract 60Cardiac insufficiency PVPI Pneumonia43

47、2Introduction to PiCCO Technology Pulmonary Permeability EVLWI answers the question:Clinical Relevance of the Pulmonary Vascular Permeability IndexPVPI answers the question:and can therefore give valuable aid for therapy guidance!肺水有多少?它是怎么来的?Introduction to PiCCO Technology Pulmonary Permeability S

48、ummary and Key Points EVLW 用于评估肺间质的含水量， 是唯一用于评估床旁肺水肿程度的参数. 血气分析和胸片用于评估肺水肿，不能提供有价值的信息 EVLW 可用于评估ICU病人死亡率 肺血管通透性指数PVPI用于鉴别静水压型肺水肿或是通透性肺水肿Introduction to PiCCO Technology EVLW and Pulmonary Permeability PiCCO plus 的连接中心静脉导管注射水温度测量管 PV4046 动脉热稀释导管（PiCCO导管） 注射水温度测量电缆PC80109 PULSION 动脉压力传感器 PV8115 PCCIAP

49、13.03 16.28 TB37.0 AP 140117 92(CVP) 5SVRI 2762PCCI 3.24HR 78SVI 42SVV 5%dPmx 1140(GEDI) 625 DPT Monitor cablePMK-206Interface cablePC80150 连接床旁监护仪PMK - XXX AUX adaptercable PC81200 CI (l/min/m2)ITBVI (ml/m2)TherapyTarget ITBVICFIEVLWI (slowly responding) 4.5 10 V+! Cattemporary750-8505.510 4.5 3.01

50、0 Cat V-temporar y750-850 5.5 10 10 V+850-100010 V+temporary750-850850850 10 V-temporary750-850 10850EVLWI (ml/kg)V+ = volume loading (! = cautiously)V- = volume contractionCat = catecholamines/ cardiovascular agents PiCCO诊断治疗树 正常值Parameter Range Unit CI 3.0 5.0 l/min/m2 SVI 40 60 ml/m2 GEDI 680 800

51、 ml/m2 ITBI 850 1000 ml/m2 ELWI* 3.0 7.0 ml/kg PVPI* 1.0 3.0 SVV 10 % PPV 10 % GEF 25 35 % CFI 4.5 6.5 1/min MAP 70 90 mmHg SVRI 1700 2400dyn*s*cm-5*m * not available in the USA (p 63) Fields of Application Septic Shock Cardiogenic Shock Hypovolaemic Shock Trauma Burns ARDS Cardiac Surgery Neuro Sur

52、gery Major Surgery 现在有效循环情况如何?.心输出量!前负荷怎样补液OR利尿?.全心舒张末期容积! 后负荷如何血管活性药物?.系统血管阻力!还是给与正性肌力药物?.左室收缩力指数!是否有肺水肿以及程度?.血管外肺水! .? ?.PiCCO临床应用CO GEDV dPmx SVR EVLW . * not available in the USA (p 63) 在重症病人中如何改善血流动力学状况 ?怎样使用 PiCCO 参数 更深刻理解急性循环衰竭时的病理生理机制 选择更合适或更符合逻辑的治疗方案 血管活性药物血管扩张 液体前负荷不足 正性肌力药物心功能衰竭 PiCCO技术有什

53、么优点？导管不经过心脏，创伤更小对每一次心脏搏动进行分析和测量（beat to beat）测量全心指标，反映全心功能，不是以右心代表整个心脏直接给出容量参数， 无需对其它指标（如压力）进行翻译不受机械通气等外部压力变化的影响 测量前负荷、后负荷和流量等多种指标在床旁就可以完成定量测量肺水肿情况， 避免X线造成的困惑技术容易掌握，并发症少适用于儿科和新生儿的病人（2公斤以上）节省医疗资源，动脉PiCCO导管可以放置10天 1. Berkenstadt H et al., Anesth Analg, 20012. Bindels A et al., Crit Care 4, 20003. Bous

54、sat S et al., Int Care Med 20024. Brock H et al., Eur J Anaesth 19 (4), 20025. Della Rocca G et al., Eur J Anaesth 19, 20026. Della Rocca G et al., Anesth Analg 95, 20027. Eisenberg PR et al., Am Rev Respir Dis 136 (3), 19878. Gdje O et al., Chest 118, 20009. Gdje O et al., Eur J of Cardio-thoracic

55、Surgery 13, 199810. Haperlin et al., Chest, 198511. Hoeft A, Yearbook of Intensive Care and Emergency Medicine, 199512. Katzenelson et al., SCCM 2001, San Diego13. Lichtwarck-Aschoff M et al., Journal of Critical Care 11 (4), 199614. Lichtwarck-Aschoff M et al., Intensive Care Med 18, 199215. Michar

56、d F et al., Yearbook of Intensive Care Med, 200216. Mitchell JP et al., Am Rev Respir Dis 145 (5), 1992 17. Neumann et al., Intensive Care Med 199918. Reuter DA et al., Crit Care Med, 200319. Reuter DA et al., Intensive Care Med, 200220. Reuter DA et al., Brit J Anaesth, 200221. Sakka SG et al., Che

57、st 122, 200222. Sakka S et al., Intensive Care Med 200023. Sakka S et al., Journal of Critical Care 14 (2), 199924. Sturm JA, Practical Applications of Fiberoptics in Critical Care Monitoring, 199025. Takeda A et al., J Vet Med Sci 57, 1995 4.参考文献 Picco临床应用 麻醉科： 麻醉科：1、急性超容量血液稀释对氧供、氧耗、循环血容量和血管外肺水的影响上

58、海第二医科大学附属瑞金医院麻醉科 于布为顾敏杰薛庆生临床麻醉学杂志2003 年1 月第19 卷第1 期2、肝移植术中容量管理上海复旦大学附属中山医院麻醉科金琳薛张纲葛圣金 国外医学麻醉学与复苏分册2005 年第26 卷第4 期3、肺癌手术中血管外肺水监测的进展四川大学华西医院(原华西医科大学附属第一医院) 麻醉科 陈果 刘斌 中国肺癌杂志2002 年2 月第5 卷第1 期4、急性高容量血液稀释对OLV犬血管外肺水的影响一温度稀释法与重量分析法的比较郑晖 苏跃 司建洛 王金珠 北京结核病胸部肿瘤研究所麻醉科中华麻醉学杂志2004年9月第24卷第9期 Picco临床应用麻醉科：5、急性高容量血液稀

59、释联合控制性降压对血管外肺水含量的影响南京医科大学第二附属医院麻醉科 杨慧蓉 临床麻醉学杂志2005 年6 月第21 卷第6 期6、扩容治疗对老年患者血液动力学和血管外肺水的影响复旦大学医学院附属中山医院麻醉科 葛宁花丁明薛张纲蒋豪 中华麻醉学杂志2001 年8 月第21 卷第8 期7、血液稀释结合控制性降压对血管外肺水的影响复旦大学医学院附属中山医院麻醉科 仓静 薛张纲 复旦大学学报 2003年7月30（4）8、 肺移植手术中的容量管理上海胸科医院 徐美英 小儿科Picco技术在小儿先天性心脏病中的临床应用研究 上海复旦大学附属儿科医院 博士学位论文 张陈 2005 Picco 在危重病儿童

60、中的应用 2005年江浙沪儿科年会交流论文 吴芳Picco临床应用 Picco临床应用呼吸内科ICU：ARDS 血管外肺水与不同血容量指标相关性的实验研究东南大学医学院附属中大医院危重病医学科 郭斐杨毅邱海波孙辉明 医学临床研究2005 年8 月第22 卷第8 期ECMO联合PICCO应用于ARDS的治疗价值上海市东医院ICU 方旭晨 上海十一五规划科研基金Picco技术在呼吸衰竭治疗中的应用价值上海华东医院RICU 朱慧莉 上海十一五科研基金 胸外科：血管外肺水和肺血容量（PBV)对于普胸手术的预后具有潜在的判断价值心脏外科：连续监测术后心脏功能和容量管理急诊科：有效稳定循环，指导临床血管活

61、性药物的使用。Picco临床应用 参数缩写PiCCO Vigilance FloTrac压力中心静脉压CVP N Y N肺动脉压PAOP N Y N血流连续心输出量CCO PCCO CCO APCO心输出量CO Y Y Y每搏输出量SV Y Y Y 前负荷 全心舒张末期容积GEDV Y CEDV(右) N胸腔内血容积ITBV Y N N容量反映值每搏量变异SVV Y N Y脉压变异PPV Y N Y 收缩力全心射血分数GEF Y RVEF N心功能指数CFI Y N N左心收缩力指数dPmx Y N N心力输出CPO PiCCO 2 N N后负荷全身血管阻力SVR Y Y Y肺相关参数血管外肺水EVLW Y N N肺血管通透性PVPI Y N N中心静脉血氧饱和度ScvO2 PiCCO 2 N Y