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1、血血流动力学监测流动力学监测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 HemoSo
2、nicTM100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，费用高监监测生命体征测生命体征MonitoringRespiration RateTemperature7一一些重要的指标些重要的指标MonitoringBlood Pressure (NiBP) no correlation with CO no correlation with oxygen deliveryECGRespiration RateTemperature8PiCCO Technology液液体
3、管理所需要的指标体管理所需要的指标Introduction to the PiCCO-TechnologyCO前负荷 EVLW收缩力指数个个性化的容量管理性化的容量管理- static - dynamicPiCCO 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.肺部通透性指数血血流流动动力学力学监测监测PiCCO 技技术术 依据经肺热稀释技术以及脉搏轮廓分析技术原原理理Left HeartRight HeartPulmonary CirculationLungsBody CirculationPULSIOCATHPULSIOCATHCV
4、CPULSIOCATH arterial thermodilution cathetercentral venous bolus injectionIntroduction to the PiCCO-Technology FunctionBolus injectionconcentration 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 FunctionLeft heartRight heartLung
5、sRARVLALVPBVEVLWEVLW原原理理胸胸腔内各腔室腔内各腔室Introduction to the PiCCO-Technology Function肺肺内内热热容容积积 (PTV)胸胸腔内热容积腔内热容积 (ITTV)Total of mixing chambers RARVLALVPBVEVLWEVLW最大混合腔室血血流流动动力学力学监测监测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 TbInjecti
6、ontD D=COTD aTb = Blood temperatureTi = Injectate 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 心心排的排的计计算算Introduction to the PiCCO-Te
7、chnology Thermodilution热稀释曲线下面积反比例反映CO 36,537510热热稀稀释释曲曲线线Normal CO: 5.5l/minIntroduction to the PiCCO-Technology Thermodilution36,53736,537Timelow CO: 1.9l/minHigh CO: 19l/minTimeTimeTemperatureTemperatureTemperature经经肺肺热热稀稀释释 vs. 肺肺动动脉脉导导管管Left heartRight HeartPulmonary CirculationLungsBody Circul
8、ationPULSIOCATH arterial thermo-dilution cathetercentral venous bolus injectionRARVPALALVAortaTranspulmonary 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
9、detected indicator but the difference in temperature over time that is relevant!Introduction to the PiCCO Technology ThermodilutionComparison with the Fick Method0,970,68 0,6237/449Sakka SG et al., Intensive Care Med 25, 1999- / - 0,19 0,219/27McLuckie A. et a., Acta Paediatr 85, 19960,960,16 0,3130
10、/150Gdje O et al., Chest 113 (4), 19980.980,32 0,2923/218Holm C et al., Burns 27, 20010,930,13 0,5260/180Della Rocca G et al., Eur J Anaest 14, 20020,95-0,04 0,4117/102Friedman Z et al., Eur J Anaest, 20020,950,49 0,4545/283Bindels AJGH et al., Crit Care 4, 20000,980,03 0,1718/54Pauli C. et al., Int
11、ensive Care Med 28, 200224/120n (Pts / Measurements)0,990,03 0,24Tibby S. et al., Intensive Care Med 23, 1997r bias SD(l/min)Comparison with Pulmonary Artery Thermodilution经经肺肺热热稀稀释释技技术术的有效性的有效性Introduction to the PiCCO Technology ThermodilutionMTt: Mean Transit time the mean time required for the i
12、ndicator to reach the detection pointDSt: Down Slope time the exponential downslope time of the thermodilution curveRecirculationte-1TbFrom the characteristics of the thermodilution curve it is possible to determine certain time parameters 对对热热稀稀释释曲曲线线做做进进一步分析一步分析 Introduction to the PiCCO-Technolog
13、y ThermodilutionInjectionIn TbMTtDStTb = blood temperature; lnTb = logarithmic blood temperature; t = timePulmonary Thermal VolumePTV = Dst x COBy using the time parameters from the thermodilution curve and the CO ITTV and PTV can be calculated 计计算算 ITTV 与与 PTVIntroduction to the PiCCO-Technology Th
14、ermodilutionRecirculationte-1TbInjectionIn TbIntrathoracic Thermal VolumeITTV = MTt x COMTtDStPulmonary Thermal Volume (PTV)Intrathoracic Thermal Volume (ITTV)Calculation of ITTV and PTVEinfhrung in die PiCCO-Technologie ThermodilutionITTV = MTt x COPTV = Dst x CO RARVLALVPBVEVLWEVLWGEDV is the diff
15、erence between intrathoracic and pulmonary thermal volumesGlobal End-diastolic Volume (GEDV)Volumetric preload parameters GEDVRARVLALVPBVEVLWEVLWITTVGEDVPTVIntroduction to the PiCCO Technology ThermodilutionVolumetric preload parameters ITBVIntrathoracic Blood Volume (ITBV)GEDVITBVPBVRARVLALVPBVEVLW
16、EVLWIntroduction to the PiCCO Technology ThermodilutionITBV 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 mlGEDV vs. ITBV in 57 Intensive Care PatientsI Intrantrat thoracic horacic B Blood lood V Volume (olume (I
17、TBVITBV) )Introduction to the PiCCO-Technology ThermodilutionITBV is calculated from the GEDV by the PiCCO Technology 01000200030000100020003000GEDV (ml)Sakka et al, Intensive Care Med 26: 180-187, 2000Summary and Key Points - ThermodilutionPiCCO 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
18、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 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Transpulmonary ThermodilutionThe pulse contour analysis is calibrated through the transpulmonary thermodilution an
19、d is a beat to beat real time analysis of the arterial pressure curveCalibration of the Pulse Contour AnalysisIntroduction to the PiCCO-Technology Pulse contour analysisInjectionPulse Contour AnalysisT = blood temperature t = timeP = blood pressure CO COTPDTPD= SV= SVTDTDHRHRPCCO = cal HR P(t)SVR+ C
20、(p) dPdt() dtCardiac OutputPatient- specific calibration factor (determined by thermodilution) Heart rateArea under the pressure curveShape of the pressure curveAortic complianceSystoleIntroduction to the PiCCO-Technology Pulse contour analysisParameters of Pulse Contour Analysis n (Pts / Measuremen
21、ts)0,940,03 0,6312 / 36Buhre W et al., J Cardiothorac Vasc Anesth 13 (4), 199919 / 7624 / 51762 / 18620 / 36025 / 38022 / 96- / -0,40 1,3Mielck et al., J Cardiothorac Vasc Anesth 17 (2), 20030,880,31 1,25Zllner C et al., J Cardiothorac Vasc Anesth 14 (2), 20000,88-0,2 1,15Gdje O et al., Crit Care Me
22、d 30 (1), 20020,94-0,02 0,74Della Rocca G et al., Br J Anaesth 88 (3), 20020,93-0,14 0,33Felbinger TW et al., J Clin Anesth 46, 2002- / - 0,14 0,58Rauch H et al., Acta Anaesth Scand 46, 2002r bias SD (l/min)Comparison with pulmonary artery thermodilutionValidation of Pulse Contour AnalysisIntroducti
23、on to the PiCCO-Technology Pulse contour analysisSVSVmaxmax SV SVminminSVV =SVV =SVSVmeanmeanSVSVmaxmaxSVSVminminSVSVmeanmeanThe Stroke Volume Variation is the variation in stroke volume over the ventilatory cycle, measured over the previous 30 second period.Parameters of Pulse Contour AnalysisIntro
24、duction to the PiCCO-Technology Pulse Contour AnalysisDynamic parameters of volume responsiveness Stroke Volume VariationThe increase of preload volume is equal: EDV1 = EDV2 SV1 SV2SVV 提示心脏对容量治疗的反应好坏提示心脏对容量治疗的反应好坏EDVSVSVV smallSVV large EDV1 EDV2 SV1 SV2PPPPmaxmax PP PPminminPPV =PPV =PPPPmeanmeanTh
25、e 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 AnalysisDynamic parameters of volume responsiveness Pulse Pressure VariationPPP
26、PmaxmaxPPPPmeanmeanPPPPminminSummary pulse contour analysis - CO and volume responsivenessPiCCO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 PiCCO-Technology Pulse contour analysisHa
27、emodynamic 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 pressure)- GEF (Global Ejection Fraction)-
28、 CFI (Cardiac Function Index)Contractility Introduction to the PiCCO-Technology Contractility parameterskgContractility parameter from the pulse contour analysisIntroduction to the PiCCO-Technology Contractility parametersdPmx = maximum velocity of pressure increaseThe contractility parameter dPmx r
29、epresents the maximum velocity of left ventricular pressure increase.Contractility parameter from the pulse contour analysisIntroduction to the PiCCO-Technology Contractility parametersfemoral dP/max mmHg/sLV dP/dtmax mmHg/sdPmx was shown to correlate well with direct measurement of velocity of left
30、 ventricular pressure increase in 70 cardiac surgery patients de Hert et al., JCardioThor&VascAnes 2006 n = 220y = -120 + (0,8* x)r = 0,82p 0,00105001000150001000150020002000500dPmx = maximum velocity of pressure increaseis calculated as 4 times the stroke volume divided by the global end-diastolic
31、volume reflects both left and right ventricular contractilityGEF = Global Ejection FractionContractility parameters from the thermodilution measurementIntroduction to the PiCCO-Technology Contractility parameters4 x SVGEF =GEDVLALVRARVCombes et al, Intensive Care Med 30, 2004GEF = Global Ejection Fr
32、action Comparison of the GEF with the gold standard TEE measured contractility in patients without right heart failuresensitivity00,40,60,8010,20,20,40,60,81 specifity2220191816128D FAC, %D GEF, %510-5-20-10102015-15-10r=076, p0,0001n=47Introduction to the PiCCO-Technology Contractility parametersCo
33、ntractility parameters from the thermodilution measurementis 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 IndexCICFI =GEDVIIntroduction to the PiCCO-Technology Contractility parametersCo
34、ntractility parameters from the thermodilution measurementCombes et al, Intensive Care Med 30, 2004sensitivity00,40,60,8010,20,20,40,60,81 specificity6543,532D FAC, %D GEF, %510-5-20-10102015-15-10r=079, p0,0001n=47CFI = Cardiac Function IndexIntroduction to the PiCCO-Technology Contractility parame
35、tersCFI was compared to the gold standard TEE measured contractility in patients without right heart failureContractility parameters from the thermodilution measurementHaemodynamic 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is calculated as the diffe
36、rence 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 catecholamine therapies(MAP CVP) x 80SVR =COAfterload parameterSVR = Systemic Vascular ResistanceMAP = Mean Arter
37、ial 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
38、应用提供了重要信息。Summary and Key PointsIntroduction to the PiCCO Technology Contractility and AfterloadHaemodynamic 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To Dry or Not to DryITTV ITBV= EVLWThe Extravascular Lung Water is the difference between the in
39、trathoracic 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)Introduction to the PiCCO Technology Extravascular Lung Water容量测量小结ITTV = CO * MTtTDaPTV = CO * DStTDaITBV = 1.25 * GE
40、DVEVLW = ITTV - ITBVGEDV = ITTV - PTVRAEDVRVEDVLAEDVLVEDVRAEDVRVEDVLAEDVLVEDVPBVRAEDVRVEDVLAEDVLVEDVPTVPTVEVLWEVLWKatzenelson et al,Crit Care Med 32 (7), 2004 Sakka et al, Intensive Care Med 26: 180-187, 2000GravimetryDye dilutionEVLW from the PiCCO technology has been shown to have a good correlati
41、on with the measurement of extravascular lung water via the gravimetry and dye dilution reference methodsValidation of Extravascular Lung Watern = 209r = 0.96ELWI by gravimetryELWI by PiCCOR = 0,97P 0.050208015-10-151060D D radiographic score-80-60-40-20D D ELWIEVLW as a quantifier of lung oedemaInt
42、roduction to the PiCCO Technology Extravascular Lung WaterELWI (ml/kg) 21 n = 5414 - 21 n = 1007 - 14 n = 174 2090100Sakka et al , Chest 2002Introduction to the PiCCO Technology Extravascular Lung WaterIntensive Care daysMitchell et al, Am Rev Resp Dis 145: 990-998, 1992 Relevance of EVLW Assessment
43、Volume management guided by EVLW can significantly reduce time on ventilation and ICU length of stay in critically ill patients, when compared to PCWP oriented therapy, Ventilation DaysPAC Groupn = 101* p 0,05PAC GroupEVLW GroupEVLW Group22 days15 days9 days7 days* p 0,05Introduction to the PiCCO Te
44、chnology Extravascular Lung WaterHaemodynamic 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 Lung OedemaPVPI = Pulmonary Vascular Permeability Indexis the ratio of Extravascular Lung Water to Pulmonary Blood Volume is a measure of the p
45、ermeability of the lung vessels and as such can classify the type of lung oedema (hydrostatic vs. permeability caused)EVLWPVPI =PBVPBVEVLWIntroduction to PiCCO Technology Pulmonary PermeabilitypermeabilityPVPI normal (1-3)PVPI raised (3)Classification of Lung Oedema with the PVPIDifference between t
46、he PVPI with hydrostatic and permeability lung oedema:Lung oedemahydrostaticPBVEVLWPBVEVLWPBVEVLWPBVEVLWIntroduction to PiCCO Technology Pulmonary Permeability16 patients with congestive heart failure and acquired pneumonia. In both groups EVLW was 16 ml/kg.Validation of the PVPIPVPI can differentia
47、te between a pneumonia caused and a cardiac failure caused lung oedema.Benedikz et al ESICM 2003, Abstract 60Cardiac insufficiencyPVPIPneumonia432Introduction to PiCCO Technology Pulmonary PermeabilityEVLWI answers the question:Clinical Relevance of the Pulmonary Vascular Permeability IndexPVPI answ
48、ers the question:and can therefore give valuable aid for therapy guidance!肺肺水有多少水有多少?它它是怎么来的是怎么来的?Introduction to PiCCO Technology Pulmonary PermeabilitySummary and Key PointsEVLW 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
49、to PiCCO Technology EVLW and Pulmonary PermeabilityPiCCO plus 的连接的连接中心静脉导管中心静脉导管注射水温度测量管注射水温度测量管 PV4046 动脉热稀释导管（动脉热稀释导管（PiCCO导管）导管） 注射水温度测量电缆注射水温度测量电缆PC80109 PULSION 动脉压力传感器动脉压力传感器 PV8115PCCIAP13.03 16.28TB37.0AP14011792(CVP)5SVRI2762PCCI3.24HR78SVI42SVV5%dPmx1140(GEDI)625DPT Monitor cablePMK-206Int
50、erface cablePC80150 连接床旁监护仪连接床旁监护仪PMK - XXX AUX adaptercable PC81200 CI(l/min/m2)ITBVI(ml/m2)TherapyTargetITBVICFIEVLWI(slowlyresponding) 4.510V+!Cattemporary750-8505.5104.53.010CatV-temporary750-8505.51010V+850-100010V+temporary750-85085085010V-temporary750-85010850EVLWI(ml/kg)V+=volumeloading(!=ca
51、utiously) V-=volumecontractionCat=catecholamines/cardiovascularagentsPiCCO诊断治疗树诊断治疗树正常值正常值ParameterRangeUnitCI3.0 5.0l/min/m2SVI40 60ml/m2GEDI680 800ml/m2ITBI850 1000ml/m2ELWI*3.0 7.0ml/kgPVPI*1.0 3.0 SVV 10%PPV 10 %GEF25 35%CFI4.5 6.51/minMAP70 90mmHgSVRI1700 2400dyn*s*cm-5*m * not available in the
52、 USA (p 63)Fields of ApplicationSeptic ShockCardiogenic ShockHypovolaemic Shock TraumaBurnsARDS Cardiac SurgeryNeuro SurgeryMajor Surgery现现在在有有效效循循环环情情况况如如何何?.心心输输出出量量!前前负负荷荷怎怎样样补补液液OR利利尿尿?.全全心心舒舒张张末末期期容容积积! 后后负负荷荷如如何何血血管管活活性性药药物物?.系系统统血血管管阻阻力力!还还是是给给与与正正性性肌肌力力药药物物?.左左室室收收缩缩力力指指数数!是是否否有有肺肺水水肿肿以以及及程程
53、度度?.血血管管外外肺肺水水! .? ?.PiCCO临床应用临床应用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技术有什么优点？导管不经过心脏，创伤更小导管不经过心脏，创伤更小对每一次心脏搏动进行分析和测量（对每一次心脏搏动进行分析和测量（beattobeat）测量全心指标，反映全心功能，不是以右心代表整个心脏测量全
54、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直接给出容量参数，无需对其它指标（如压力）进行翻译无需对其它指标（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测量前负荷、后负荷和流量等多种指标在在床床旁旁就就可可以以完完成成定定量量测测量量肺肺水水肿肿情情况况， 避避免免X线线造造成成的困惑的困惑技术容易掌握，并发症少技术容易掌握，并发症少适用于儿科和新生儿的病人（适用于儿科和新生儿的病人（2公斤以上）公斤以上）节省医疗资源，动脉节省医疗资源，动脉PiCCO导管可以放置导管可以放置10天天1.Berkenstad
55、t H et al., Anesth Analg, 20012.Bindels A et al., Crit Care 4, 20003.Boussat 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
56、O et al., Chest 118, 20009.Gdje O et al., Eur J of Cardio-thoracic 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.Lich
57、twarck-Aschoff M et al., Intensive Care Med 18, 199215.Michard F et al., Yearbook of Intensive Care Med, 200216.Mitchell JP et al., Am Rev Respir Dis 145 (5), 199217.Neumann et al., Intensive Care Med 199918.Reuter DA et al., Crit Care Med, 200319.Reuter DA et al., Intensive Care Med, 200220.Reuter
58、DA et al., Brit J Anaesth, 200221.Sakka SG et al., Chest 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, 19954.参考文献参考文献
59、Picco临床应用麻醉科：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
60、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 小儿科小儿科Picco技术在小儿
61、先天性心脏病中的临床应用研究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上海复旦大学附属儿科医院 博士学位论文博士学位论文 张陈张陈 2005 Picco 在危重病儿童中的应用在危重病儿童中的应用 2005年江浙沪儿科年年江浙沪儿科年会交流论文会交流论文 吴芳吴芳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I
62、CU 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，指导临床血管活性药物的使用。Picco临床应用参数缩写PiCCOVigilanceFloTrac压力压力中心静脉压中心静脉压CVPNYN肺动脉压肺动脉压PAOPNYN血流血流连续心输出量连续心输出量CCOPCCOCCOAPCO心输出量心输出量COYYY每搏输出量每搏输出量SVYYY前负荷前负荷全心舒张末期容积全心舒张末期容积GEDVYCEDV(右右)N胸腔内血容积胸腔内血容积ITBVYNN容量反映值容量反映值每搏量变异每搏量变异SVVYNY脉压变异脉压变异PPVYNY收缩力收缩力全心射血分数全心射血分数GEFYRVEFN心功能指数心功能指数CFIYNN左心收缩力指数左心收缩力指数dPmxYNN心力输出心力输出CPOPiCCO2NN后负荷后负荷全身血管阻力全身血管阻力SVRYYY肺相关参数肺相关参数血管外肺水血管外肺水EVLWYNN肺血管通透性肺血管通透性PVPIYNN氧和参数氧和参数中心静脉血氧饱和度中心静脉血氧饱和度ScvO2PiCCO2NY混合静脉血氧饱和度混合静脉血氧饱和度SvO2NYN
