簡(jiǎn)介:危重病患者的血流動(dòng)力學(xué)監(jiān)測(cè)FOCUSONPICCO,北京協(xié)和醫(yī)院杜斌,血流動(dòng)力學(xué)監(jiān)測(cè)增加患者病死率,CONNORSAFJR,SPEROFFT,DAWSONNV,THOMASC,HARRELFEJR,WAGNERD,DESBJENSN,GOLDMANL,WUAW,CALIFFRM,FULKERSONWJJR,VIDAILLETH,BROSTES,BELLAMYP,LYNNJ,KNAUSWATHEEFFECTIVENESSOFRIGHTHEARTCATHETERIZATIONINTHEINITIALCAREOFCRITICALLYILLPATIENTSSUPPORTINVESTIGATORSJAMA199627611889897,血流動(dòng)力學(xué)監(jiān)測(cè)為何不能改善預(yù)后,不恰當(dāng)?shù)倪m應(yīng)癥PAC的副作用或并發(fā)癥獲得數(shù)據(jù)的方法不正確儀器定標(biāo)錯(cuò)誤,或傳感器位置錯(cuò)誤獲得的數(shù)據(jù)不能反映血流動(dòng)力學(xué)狀態(tài)錯(cuò)誤使用數(shù)據(jù)對(duì)數(shù)據(jù)的解讀錯(cuò)誤作出治療決定前未考慮其他相關(guān)因素CXR,尿量,血清白蛋白采用的治療措施無效或有害無需血流動(dòng)力學(xué)監(jiān)測(cè)時(shí)未及時(shí)拔除PAC,PAC的使用減少ILLINOIS,USA,APPAVUS,COWENJ,BUNYERMTHEUSEOFPULMONARYARTERYCATHETERIZATIONHASDECLINEDCRITICALCARE20059SUPPL1P69DOI101186/CC3132,PAC的使用減少ILLINOIS,USA,APPAVUS,COWENJ,BUNYERMTHEUSEOFPULMONARYARTERYCATHETERIZATIONHASDECLINEDCRITICALCARE20059SUPPL1P69DOI101186/CC3132,臨床評(píng)價(jià)VS血流動(dòng)力學(xué),目的評(píng)價(jià)肺動(dòng)脈導(dǎo)管PAC得到的血流動(dòng)力學(xué)指標(biāo)是否能夠改變患者的治療設(shè)計(jì)前瞻性觀察患者103例留置PAC的患者方法插管前,請(qǐng)醫(yī)生對(duì)一些血流動(dòng)力學(xué)指標(biāo)的范圍,診斷及治療方案進(jìn)行預(yù)測(cè)插管后,復(fù)習(xí)患者病例,記錄插管時(shí)及置管8小時(shí)內(nèi)的血流動(dòng)力學(xué),EISENBERGPR,JAFFEAS,SCHUSTERDPCLINICALEVALUATIONCOMPAREDTOPULMONARYARTERYCATHETERIZATIONINTHEHEMODYNAMICASSESSMENTOFCRITICALLYILLPATIENTSCRITCAREMED1984127549553,臨床評(píng)價(jià)VS血流動(dòng)力學(xué),EISENBERGPR,JAFFEAS,SCHUSTERDPCLINICALEVALUATIONCOMPAREDTOPULMONARYARTERYCATHETERIZATIONINTHEHEMODYNAMICASSESSMENTOFCRITICALLYILLPATIENTSCRITCAREMED1984127549553,臨床評(píng)價(jià)VS血流動(dòng)力學(xué),結(jié)果留置PAC后計(jì)劃治療方案需要改變58應(yīng)用未預(yù)計(jì)到的治療方案30,EISENBERGPR,JAFFEAS,SCHUSTERDPCLINICALEVALUATIONCOMPAREDTOPULMONARYARTERYCATHETERIZATIONINTHEHEMODYNAMICASSESSMENTOFCRITICALLYILLPATIENTSCRITCAREMED1984127549553,臨床評(píng)價(jià)VS血流動(dòng)力學(xué),結(jié)論單純根據(jù)臨床表現(xiàn)難以準(zhǔn)確預(yù)測(cè)血流動(dòng)力學(xué)指標(biāo)PAC監(jiān)測(cè)數(shù)據(jù)通常能夠改變治療方案,EISENBERGPR,JAFFEAS,SCHUSTERDPCLINICALEVALUATIONCOMPAREDTOPULMONARYARTERYCATHETERIZATIONINTHEHEMODYNAMICASSESSMENTOFCRITICALLYILLPATIENTSCRITCAREMED1984127549553,血流動(dòng)力學(xué)數(shù)據(jù)的解釋,臨床場(chǎng)景N44心臟外科術(shù)后16ARDS9全身性感染9心源性休克5其他情況5,SQUARAP,FOURQUETE,JACQUETL,BROCCARDA,UHLIGT,RHODESA,BAKKERJ,PERRETCACOMPUTERPROGRAMFORINTERPRETINGPULMONARYARTERYCATHETERIZATIONDATARESULTSOFTHEEUROPEANHEMODYNRESIDENTSTUDYINTENSIVECAREMED200329735741,血流動(dòng)力學(xué)數(shù)據(jù)的解釋,SQUARAP,FOURQUETE,JACQUETL,BROCCARDA,UHLIGT,RHODESA,BAKKERJ,PERRETCACOMPUTERPROGRAMFORINTERPRETINGPULMONARYARTERYCATHETERIZATIONDATARESULTSOFTHEEUROPEANHEMODYNRESIDENTSTUDYINTENSIVECAREMED200329735741,血流動(dòng)力學(xué)數(shù)據(jù)的解釋,SQUARAP,FOURQUETE,JACQUETL,BROCCARDA,UHLIGT,RHODESA,BAKKERJ,PERRETCACOMPUTERPROGRAMFORINTERPRETINGPULMONARYARTERYCATHETERIZATIONDATARESULTSOFTHEEUROPEANHEMODYNRESIDENTSTUDYINTENSIVECAREMED200329735741,血流動(dòng)力學(xué)參數(shù)改變治療決定,SQUARAP,BENNETTD,PERRETCPULMONARYARTERYCATHETERDOESTHEPROBLEMLIEINTHEUSERSCHEST200212120092015,ICU患者的輸液治療,輸液治療的決定因素臨床經(jīng)驗(yàn)中心靜脈壓或肺動(dòng)脈楔壓,BOLDTJ,LENZM,KUMLEB,PAPSDORFMVOLUMEREPLACEMENTSTRATEGIESONINTENSIVECAREUNITSRESULTSFROMAPOSTALSURVEYINTENSIVECAREMED199824147151,臨床判斷缺乏準(zhǔn)確性PAWP,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0,10,15,19,19,15,10,0,預(yù)計(jì)PAWPMMHG,測(cè)定PAWPMMHG,EISENBERGPL,JAFFEAS,SCHUSTERDPCLINICALEVALUATIONCOMPAREDTOPULMONARYARTERYCATHETERIZATIONINTHEHEMODYNAMICASSESSMENTOFCRITICALLYILLPATIENTSCRITCAREMED1984127549553,,,NOCHANGEINPLANNEDTHERAPYAFTERCATHETERIZATION,CHANGEINPLANNEDTHERAPYAFTERCATHETERIZATION,,,,,,,0,,,,,,臨床判斷缺乏準(zhǔn)確性CO,,,,,,,,,,,,,,,,0,45,70,預(yù)計(jì)COL/MIN,測(cè)定COL/MIN,EISENBERGPL,JAFFEAS,SCHUSTERDPCLINICALEVALUATIONCOMPAREDTOPULMONARYARTERYCATHETERIZATIONINTHEHEMODYNAMICASSESSMENTOFCRITICALLYILLPATIENTSCRITCAREMED1984127549553,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,45,70,臨床判斷缺乏準(zhǔn)確性,EISENBERGPL,JAFFEAS,SCHUSTERDPCLINICALEVALUATIONCOMPAREDTOPULMONARYARTERYCATHETERIZATIONINTHEHEMODYNAMICASSESSMENTOFCRITICALLYILLPATIENTSCRITCAREMED1984127549553,HOWGOODAREOURCLINICALSKILLS,CARDIACOUTPUTWEDGEPRESSURE,BAYLISSBMJ‘83CCUPTS7162,臨床判斷缺乏準(zhǔn)確性,CLINICALEVALUATIONCOMPAREDTOPULMONARYARTERYCATHETERIZATIONINTHEHEMODYNAMICASSESSMENTOFCRITICALLYILLPATIENTSEISENBERGPR,ETALCRITCAREMED198412349ASSESSINGHEMODYNAMICSTATUSINCRITICALLYILLPATIENTSDOPHYSICIANSUSECLINICALINFORMATIONOPTIMALLYCONNORSAF,ETALJCRITCARE19872174THERAPEUTICIMPACTOFPACINTHEICUSTEINGRUB,ETALCHEST1991991451PACINCRITICALLYILLPATIENTSAPROSPECTIVEANALYSISOFOUTCOMECHANGESASSOCIATEDWITHCATHETERPROMPTEDCHANGESINTHERAPYMIMOZOETALCRITCAREMED199422573HEMODYNAMICANDPULMONARYFLUIDSTATUSINTHETRAUMAPATIENTAREWESLIPPINGVEALEWNJR,ETALAMSURG200571621,臨床判斷缺乏準(zhǔn)確性,醫(yī)生常常相信自己的判斷,但自信與準(zhǔn)確性之間并無相關(guān)性與經(jīng)驗(yàn)較少的醫(yī)生相比,盡管有經(jīng)驗(yàn)的醫(yī)生更為自信,但他們的判斷并不準(zhǔn)確醫(yī)生不應(yīng)盲目根據(jù)自己對(duì)心臟功能的判斷,作為治療決策的依據(jù),DAWSONNVETALHEMODYNAMICASSESSMENTINMANAGINGTHECRITICALLYILLISPHYSICIANCONFIDENCEWARRANTEDMEDDECISMAKING199313258266,臨床判斷血流動(dòng)力學(xué)的準(zhǔn)確性,臨床重要的血流動(dòng)力學(xué)參數(shù),SQUARAP,BENNETTD,PERRETCPULMONARYARTERYCATHETERDOESTHEPROBLEMLIEINTHEUSERSCHEST200212120092015,心臟手術(shù)后患者的血流動(dòng)力學(xué)監(jiān)測(cè),問卷調(diào)查39個(gè)問題血流動(dòng)力學(xué)監(jiān)測(cè)容量替代正性肌力藥物/升壓藥物輸血德國(guó)的80個(gè)ICU主任問卷回收率69,KASTRUPM,MARKEWITZA,SPIESC,CARLM,ERBJ,GRO?EJ,SCHIRMERUCURRENTPRACTICEOFHEMODYNAMICMONITORINGANDVASOPRESSORANDINOTROPICTHERAPYINPOSTOPERATIVECARDIACSURGERYPATIENTSINGERMANYRESULTSFROMAPOSTALSURVEYACTAANAESTHESIOLOGICASCANDINAVICA2007513347358,心臟手術(shù)后患者的血流動(dòng)力學(xué)監(jiān)測(cè),KASTRUPM,MARKEWITZA,SPIESC,CARLM,ERBJ,GRO?EJ,SCHIRMERUCURRENTPRACTICEOFHEMODYNAMICMONITORINGANDVASOPRESSORANDINOTROPICTHERAPYINPOSTOPERATIVECARDIACSURGERYPATIENTSINGERMANYRESULTSFROMAPOSTALSURVEYACTAANAESTHESIOLOGICASCANDINAVICA2007513347358,英格蘭與威爾士ICU的CO監(jiān)測(cè)技術(shù),ESDAILEB,RAOBAIKADYRSURVEYOFCARDIACOUTPUTMONITORINGININTENSIVECAREUNITSINENGLANDANDWALESCRITICALCARE20059SUPPL1P68DOI101186/CC3131,英格蘭與威爾士ICU的CO監(jiān)測(cè)技術(shù),CO監(jiān)測(cè)技術(shù)?2種69首選經(jīng)食道多普勒監(jiān)測(cè)CO41常規(guī)監(jiān)測(cè)SCVO220,ESDAILEB,RAOBAIKADYRSURVEYOFCARDIACOUTPUTMONITORINGININTENSIVECAREUNITSINENGLANDANDWALESCRITICALCARE20059SUPPL1P68DOI101186/CC3131,AREWEUSINGPACCORRECTLY,,PAWP測(cè)定中的技術(shù)問題,MORRISAH,CHAPMANRH,GARDNERRMFREQUENCYOFTECHNICALPROBLEMSENCOUNTEREDINTHEMEASUREMENTOFPULMONARYARTERYWEDGEPRESSURECRITCAREMED1984123164170,PAWP測(cè)定中的技術(shù)問題,MORRISAH,CHAPMANRH,GARDNERRMFREQUENCYOFTECHNICALPROBLEMSENCOUNTEREDINTHEMEASUREMENTOFPULMONARYARTERYWEDGEPRESSURECRITCAREMED1984123164170,WPINITIAL–WPCONFIRMED11?6MMHGRANGE13,22,PAWP測(cè)定中的技術(shù)問題,MORRISAH,CHAPMANRH,GARDNERRMFREQUENCYOFWEDGEPRESSUREERRORSINTHEICUCRITCAREMED1985139705708,PAWP測(cè)定中的技術(shù)問題,MORRISAH,CHAPMANRH,GARDNERRMFREQUENCYOFWEDGEPRESSUREERRORSINTHEICUCRITCAREMED1985139705708,ICU醫(yī)生缺乏PAC的相關(guān)知識(shí),目的評(píng)價(jià)歐洲國(guó)家ICU醫(yī)生對(duì)PAC相關(guān)知識(shí)的了解程度設(shè)計(jì)調(diào)查問卷背景86個(gè)歐洲大學(xué)及非大學(xué)醫(yī)院ICU對(duì)象從兩個(gè)歐洲危重病醫(yī)學(xué)會(huì)目錄中選取134個(gè)ICU其中86個(gè)ICU的535名醫(yī)生參加問卷調(diào)查干預(yù)在每個(gè)ICU中,所有醫(yī)生均被要求同時(shí)完成一項(xiàng)調(diào)查問卷,包括31個(gè)多選題,涉及床旁留置PAC的所有方面,GNAEGIA,FEIHLF,PERRETCINTENSIVECAREPHYSICIAN’SINSUFFICIENTKNOWLEDGEOFRIGHTHEARTCATHETERIZATIONATTHEBEDSIDETIMETOACTCRITCAREMED199725213220,ICU醫(yī)生缺乏PAC的相關(guān)知識(shí),GNAEGIA,FEIHLF,PERRETCINTENSIVECAREPHYSICIAN’SINSUFFICIENTKNOWLEDGEOFRIGHTHEARTCATHETERIZATIONATTHEBEDSIDETIMETOACTCRITCAREMED199725213220,ICU醫(yī)生缺乏PAC的相關(guān)知識(shí),GNAEGIA,FEIHLF,PERRETCINTENSIVECAREPHYSICIAN’SINSUFFICIENTKNOWLEDGEOFRIGHTHEARTCATHETERIZATIONATTHEBEDSIDETIMETOACTCRITCAREMED199725213220,ICU醫(yī)生缺乏PAC的相關(guān)知識(shí),GNAEGIA,FEIHLF,PERRETCINTENSIVECAREPHYSICIAN’SINSUFFICIENTKNOWLEDGEOFRIGHTHEARTCATHETERIZATIONATTHEBEDSIDETIMETOACTCRITCAREMED199725213220,ICU醫(yī)生缺乏PAC的相關(guān)知識(shí),GNAEGIA,FEIHLF,PERRETCINTENSIVECAREPHYSICIAN’SINSUFFICIENTKNOWLEDGEOFRIGHTHEARTCATHETERIZATIONATTHEBEDSIDETIMETOACTCRITCAREMED199725213220,ICU醫(yī)生缺乏PAC的相關(guān)知識(shí),GNAEGIA,FEIHLF,PERRETCINTENSIVECAREPHYSICIAN’SINSUFFICIENTKNOWLEDGEOFRIGHTHEARTCATHETERIZATIONATTHEBEDSIDETIMETOACTCRITCAREMED199725213220,ISTHEREANEASYALTERNATIVETOTHISDILEMMA,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,CENTRALVENOUSCATHETER,INJECTATETEMPERATURESENSORHOUSINGPV4046,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,ARTERIALTHERMODILUTIONCATHETER,INJECTATETEMPERATURESENSORCABLEPC80109,PULSIONDISPOSABLEPRESSURETRANSDUCERPV8115,,,,PCCI,AP,13031628TB370,AP14011792CVP5SVRI2762PCCI324HR78SVI42SVV5DPMX1140GEDI625,,,,,,,,,,,,,,,,,,,,,,,,,DPTMONITORCABLEPMK206,INTERFACECABLEPC80150,,,,,,CONNECTIONCABLETOBEDSIDEMONITORPMKXXX,AUXADAPTERCABLEPC81200,PICCO的技術(shù)原理,PICCO技術(shù)由下列兩種技術(shù)組成,用于更有效地進(jìn)行血流動(dòng)力和容量治療,使大多數(shù)病人不必使用肺動(dòng)脈導(dǎo)管,心輸出量的測(cè)定經(jīng)肺熱稀釋技術(shù),中心靜脈內(nèi)注射指示劑后,動(dòng)脈導(dǎo)管尖端的熱敏電阻測(cè)量溫度下降的變化曲線通過分析熱稀釋曲線,使用STEWARTHAMILTON公式計(jì)算得出心輸出量CO,心輸出量的測(cè)定經(jīng)肺熱稀釋技術(shù),經(jīng)肺熱稀釋測(cè)量只需要在中心靜脈內(nèi)注射冷100時(shí),胸片才會(huì)發(fā)生改變BONGARDFS,SURGERY1984胸片對(duì)EVLW的改變并不敏感HELPERINBD,CHEST1984確定患者是否符合ARDS影像學(xué)表現(xiàn)時(shí),醫(yī)生之間存在非常明顯的差異RUBENFELDETAL,CHEST1999,容量測(cè)量小結(jié),ITTVCOXMTTTDA,PTVCOXDSTTDA,ITBV125XGEDV,EVLWITTV–ITBV,GEDVITTV–PTV,,,,EVLWPICCOVS重力法測(cè)定,STURM,INPRACTICALAPPLICATIONSOFFIBEROPTICSINCRITICALCAREMONITORING,SPRINGERVERLAGBERLINHEIDELBERGNEWYORK1990,PP129139,血管外肺水的臨床驗(yàn)證,SAKKAETAL,INTENSIVECAREMED26180187,2000,BIAS02ML/KGSD14ML/KG,N209R096,EVLWISTVSEVLWITDIN209INTENSIVECAREPATIENTS,減少血管外肺水臨床試驗(yàn),MITCHELLETAL,AMREVRESPDIS145990998,1992,血管外肺水,血管外肺水EVLW通過經(jīng)肺熱稀釋法得到,已被染料稀釋法和重量法證實(shí)已證實(shí)血管外肺水EVLW與ARDS的嚴(yán)重程度,病人機(jī)械通氣的天數(shù),住ICU的時(shí)間及死亡率明確相關(guān),其評(píng)估肺水腫遠(yuǎn)遠(yuǎn)優(yōu)于胸部X線肺血管通透性指數(shù)PVPI一定程度上反映了肺水腫形成的原因PVPIEVLW/PBV,隱匿性肺水腫的檢測(cè),原發(fā)性與繼發(fā)性ARDS/ALI的鑒別,患者人群N10原發(fā)性ARDS/ALIN4肺炎,誤吸繼發(fā)性ARDS/ALIN6全身性感染評(píng)價(jià)指標(biāo)ITBVIEVLWIPVPIEVLW/ITBV,MORISAWAK,TAIRAY,TAKAHASHIH,MATSUIK,OUCHIM,FUJINAWAN,NODAKDOTHEDATAOBTAINEDBYTHEPICCOSYSTEMENABLEONETODIFFERENTIATEBETWEENDIRECTALI/ARDSANDINDIRECTALI/ARDSCRITICALCARE2006,10SUPPL1P326DOI101186/CC4673,原發(fā)性與繼發(fā)性ARDS/ALI的鑒別,MORISAWAK,TAIRAY,TAKAHASHIH,MATSUIK,OUCHIM,FUJINAWAN,NODAKDOTHEDATAOBTAINEDBYTHEPICCOSYSTEMENABLEONETODIFFERENTIATEBETWEENDIRECTALI/ARDSANDINDIRECTALI/ARDSCRITICALCARE2006,10SUPPL1P326DOI101186/CC4673,SIRS及ARDS肺血管通透性與肺水腫,TAGAMIT,KUSHIMOTOS,ATSUMIT,MATSUDAK,MIYAZAKIY,OYAMAR,KOIDOY,KAWAIM,YOKOTAH,YAMAMOTOYINVESTIGATIONOFTHEPULMONARYVASCULARPERMEABILITYINDEXANDEXTRAVASCULARLUNGWATERINPATIENTSWITHSIRSANDARDSUNDERTHEPICCOSYSTEMCRITICALCARE200610SUPPL1P352DOI101186/CC4699,血管外肺水的測(cè)定,胸片,氧合障礙及PAWP與EVLW之間的相關(guān)性很差床旁測(cè)定EVLW為危重病患者的診斷,隨訪及治療評(píng)估提供了新的方法,
下載積分: 4 賞幣
上傳時(shí)間:2024-01-06
頁(yè)數(shù): 110
大?。?4.54(MB)
子文件數(shù):