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1、,Introduction to PiCCO Technology PiCCO技术的介绍,Principles of function 理论知识 Thermodilution 热稀释法 Pulse contour analysis 脉搏轮廓分析法 Contractility parameters 收缩力参数 Afterload parameters 后负荷参数 Extravascular lung water 血管外肺水 Pulmonary permeability 肺通透性指数,血流动力学监测,Theory and Practice,PiCCO Technology,Parameters f
2、or guiding volume therapy,Introduction to the PiCCO-Technology,CO 心排量,Volumetric preload 容量负荷,EVLW 肺水,Contractility 收缩力,Differentiated Volume Management,-static - dynamic -,PiCCO Technology is a combination of transpulmonary thermodilution and pulse contour analysis PiCCO技术是经肺热稀释法和脉搏轮廓分析法的结合,Princip
3、les of Measurement,Left Heart,Right Heart,Pulmonary Circulation,Lungs,Body Circulation,PULSIOCATH,PULSIOCATH,CVC,PULSIOCATH arterial thermodilution catheter,central venous bolus injection,Introduction to the PiCCO-Technology Function,Bolus injection,concentration changes over time (Thermodilution cu
4、rve),After central venous injection the cold bolus sequentially passes through the various intrathoracic compartments 中心静脉弹丸注射后，冰盐水会通过胸腔内的各个腔室。,The temperature change over time is registered by a sensor at the tip of the arterial catheter 动脉导管尖端的感受器探测到注射液温度的改变。,Introduction to the PiCCO-Technology F
5、unction,Left heart,Right heart,Lungs,Principles of Measurement,Intrathoracic Compartments (mixing chambers),Introduction to the PiCCO-Technology Function,Pulmonary Thermal Volume (PTV) 肺内热稀释容积,Intrathoracic Thermal Volume (ITTV) 胸腔内热容积,Total of mixing chambers 所有的混合腔室,Largest single mixing chamber 最
6、大的单一混合腔室,Haemodynamic Monitoring,E. Introduction to PiCCO Technology,Principles of function Thermodilution Pulse contour analysis Contractility parameters Afterload parameters Extravascular Lung Water Pulmonary Permeability,Tb x dt,(Tb - Ti) x Vi x K,Tb,Injection,t,D,=,COTD a,Tb = Blood temperature
7、Ti = Injectate temperature Vi = Injectate volume Tb . dt = Area under the thermodilution curve K = Correction constant, made up of specific weight and specific heat of blood and injectate,The CO is calculated by analysis of the thermodilution curve using the modified Stewart-Hamilton algorithm 心排量是通
8、过分析热稀释曲线得来的，应用Stewart-Hamilton定律。,Calculation of the Cardiac Output,Introduction to the PiCCO-Technology Thermodilution,The area under the thermodilution curve is inversely proportional to the CO. 热稀释曲线下的面积是与CO呈反比的。,36,5,37,5,10,Thermodilution curves,Normal CO: 5.5l/min,Introduction to the PiCCO-Tec
9、hnology Thermodilution,36,5,37,36,5,37,Time,low CO: 1.9l/min,High CO: 19l/min,Time,Time,Temperature,Temperature,Temperature,Transpulmonary vs. Pulmonary Artery Thermodilution,Left heart,Right Heart,Pulmonary Circulation,Lungs,Body Circulation,PULSIOCATH arterial thermo-dilution catheter,central veno
10、us bolus injection,RA,RV,PA,LA,LV,Aorta,Transpulmonary TD (PiCCO),Pulmonary Artery TD (PAC),In both procedures only part of the injected indicator passes the thermistor. 在这两种方式中只有一部分注射液会通过热敏感受器。 Nonetheless the determination of CO is correct, as it is not the amount of the detected indicator but the
11、 difference in temperature over time that is relevant! 但是CO正确与否的决定性因素，并不是指示剂的量，而是随着时间变化导致的温度变化，这两者相关的。,Introduction to the PiCCO Technology Thermodilution,Comparison with the Fick Method,0,97,0,68 0,62,37/449,Sakka SG et al., Intensive Care Med 25, 1999,- / -,0,19 0,21,9/27,McLuckie A. et a., Acta P
12、aediatr 85, 1996,0,96,0,16 0,31,30/150,Gdje O et al., Chest 113 (4), 1998,0.98,0,32 0,29,23/218,Holm C et al., Burns 27, 2001,0,93,0,13 0,52,60/180,Della Rocca G et al., Eur J Anaest 14, 2002,0,95,-0,04 0,41,17/102,Friedman Z et al., Eur J Anaest, 2002,0,95,0,49 0,45,45/283,Bindels AJGH et al., Crit
13、 Care 4, 2000,0,98,0,03 0,17,18/54,Pauli C. et al., Intensive Care Med 28, 2002,24/120,n (Pts / Measurements),0,99,0,03 0,24,Tibby S. et al., Intensive Care Med 23, 1997,r,bias SD(l/min),Comparison with Pulmonary Artery Thermodilution,Validation of the Transpulmonary Thermodilution,Introduction to t
14、he PiCCO Technology Thermodilution,MTt: Mean Transit time the mean time required for the indicator to reach the detection point,DSt: Down Slope time the exponential downslope time of the thermodilution curve,Recirculation,t,e-1,Tb,From the characteristics of the thermodilution curve it is possible t
15、o determine certain time parameters 从热稀释曲线的特点来看，它是可以决定某些时间参数的。,Extended analysis of the thermodilution curve,Introduction to the PiCCO-Technology Thermodilution,Injection,In Tb,MTt,DSt,Tb = blood temperature; lnTb = logarithmic blood temperature; t = time,Pulmonary Thermal Volume PTV = Dst x CO,By using the time parameters from the thermodilution curve and the CO ITTV and
