picco监测及临床应用

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1、PiCCO的临床应用内容原理测定参数临床操作临床病例心排监测探讨PiCCO原理PiCCOPulsecontourcardiacoutputpulseindicatorcontinuecardiacoutputPiCCO采用成熟的热稀释方法测量单次的心输出量（CO），并通过分析动脉压力波形曲线下面积与CO存在的一定关系，来获得连续的心输出量（CCO）a.经肺热稀释技术b.动脉脉搏轮廓分析技术Picco技术获得连续CO的基本原理Wesseling提出的心搏量同主动脉压力曲线的收缩面积成正比，压力依赖于顺应性及其系统阻力，并作了压力、心率、年龄等影响因素校正后

2、，该方法才得到认可。PiCCOplussetupCentralvenouscatheterInjectatetemperaturesensorhousingPV4046ArterialthermodilutioncatheterInjectatetemperaturesensorcablePC80109PULSIONdisposablepressuretransducerPV8115PCCIAP13.0316.28TB37.0AP14011792(CVP)5SVRI2762PCCI3.24HR78SVI42SVV5%dPmx1140(GEDI)625DP

3、TMonitorcablePMK-206InterfacecablePC80150ConnectioncabletobedsidemonitorPMK-XXXAUXadaptercablePC81200A.axillaris(A.brachialis)PV2014L084F8cmA.radialisPV2014L50LGWA4F50cmA.femoralisPV2015L205F20cmPV2013L07*3F7cmPV2014L08*morethan10kgbodyweight*ForapplicationinpediatricpatientsAppl

4、icationsitesforthermodilutioncathetersTbinjectiontTranspulmonarythermodilution:CardiacOutputStewart-HamiltonmethodTb=BloodtemperatureTi=InjectatetemperatureVi=Injectatevolume∫∆Tb.dt=AreaunderthethermodilutioncurveK=Correctionconstant,madeupofspecificweightandspecificheatofbloodan

5、dinjectateAreaunderpressurecurveShapeofpressurecurvePCCO=cal•HR•SystoleP(t)SVR+C(p)•dPdt()dtAorticcomplianceHeartratePatient-specificcalibrationfactor(determinedbythermodilution)t[s]P[mmHg]CalculationofPCCOModelPCCOisdisplayedaslast12smeanMethodologyofvolumetricmonitoring(I)

6、lnc(I)injectionAtrecirculationMTtte-1DStc(I)MTt:Meantransittime≈halfoftheindicatorpassedthepointofdetectionDSt:Downslopetime≈exponentialdownslopetimeofTDcurveITTV=CO*MTtTDaPTV=CO*DStTDaITBV=1.25*GEDVEVLW=ITTV-ITBVGEDV=ITTV-PTVRAEDVRVEDVLAEDVLVEDVRAEDVRVEDVLAEDVLVEDVPBVRAEDVRVEDVL

7、AEDVLVEDVPTVPTVEVLWEVLWCalculationofvolumesPiCCO测定的参数TranspulmonarythermodilutionparametersCardiacoutputCO（心排血量）IntrathoracicbloodvolumeITBV（胸腔内血容量）ExtravascularlungwaterEVLW（血管外肺水）CardiacfunctionindexCFI（心功能指数）GlobalejectionfractionGEF(心脏腔室射血分数)经肺热稀释测量的参数NewparametersGEF=GEDV4xS

8、VGlobalejectionfractionPVPI=PBVEVLWEstim