血流动力学监测与心脏超声.ppt

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1、指南解读：血流动力学监测与心脏超声（CUS）SLAX:肋下长轴切面SIVC:肋下下腔静脉切面PLAX：胸骨旁长轴切面PSAX:胸骨旁短轴切面A4CH:心尖四腔心切面CUS最常用的五个切面AntonelliM,etal.IntensiveCareMed.2007;33(4):575-90.CecconiM,etal.IntensiveCareMed.2014;40(12):1795-815.25位专家组成的团队12位专家组成的团队FiveSpecificQuestions(1)Whataretheepidemiologicandpathophysiologicfeatures

2、ofshockintheintensivecareunit?(2)Shouldwemonitorpreloadandfluidresponsivenessinshock?(3)Howandwhenshouldwemonitorstrokevolumeorcardiacoutputinshock?(4)Whatmarkersoftheregionalandmicrocirculationcanbemonitored,andhowcancellularfunctionbeassessedinshock?(5)Whatistheevidenceforusinghemodynami

3、cmonitoringtodirecttherapyinshock?2014ConsensusRecommendedagainst常规使用:(1)thepulmonaryarterycatheterinshock休克患者使用肺动脉导管(2)staticpreloadmeasurementsusedalonetopredictfluidresponsiveness仅仅使用静态的前负荷测量方法来预测液体反应性MaindifferencesBloodpressurestatementsICM2007ICM2014FluidresponsivenessstatementsICM20

4、07ICM2014ICM2007HemodynamicmonitoringICM2014CecconiM,etal.IntensiveCareMed.2014;40(12):1795-815.Mainnewstatements(1)Statementsonindividualizingbloodpressuretargets;(2)Statementsontheassessmentandpredictionoffluidresponsiveness;(3)Statementsontheuseofechocardiographyandhemodynamicmonitoring

5、.2014ConsensusIdentificationofthetypeofshock•Werecommendfurtherhemodynamicassessment(suchasassessingcardiacfunction)todeterminethetypeofshockiftheclinicalexaminationdoesnotleadtoacleardiagnosis.BestpracticeWesuggestthat,whenhemodynamicassessmentisneeded,echocardiographyisthepreferredmodali

6、tytoinitiallyevaluatethetypeofshockasopposedtomoreinvasivetechnologies.Recommendation.Level2;QoE(B)Rationale:Contextanalysis(trauma,infection,chestpain,etc.)andclinicalevaluationwhichfocusesonskinperfusionandjugularveindistensionusuallyorientdiagnosistothetypeofshock,butcomplexsituationsma

7、yexist(e.g.cardiactamponadeinapatientwithtraumaorsepticshockinapatientwithchronicheartfailure)inwhichadiagnosisismoredifficult.VincentJL,etal.NEnglJMed.2013;369(18):1726-34.ManifestationonEcho梗阻性心包填塞FOCUS的测量很迅速，即使是初学者，一般时间也小于3min；FOCUS应当被列入重症培训的项目中去。BeraudAS,e