picco课件..ppt

,PULSIONPiCCOplus,Pulse-inducedcontourcardiacoutput,1,1.PiCCO技术的原理是什么？2.PiCCO的主要测量参数有哪些?3.PiCCO技术的临床应用诊断治疗树4.如何应用PiCCO技术？5.PiCCO技术有什么优点6.护理,2,什么是PiCCO技术?,PiCCO技术是经肺热稀释技术和脉搏波型轮廓分析技术的综合，用于进一步的测量血液动力监测和容量管理，并使大多数病人不再需要放置肺动脉导管：,脉搏轮廓分析技术,中心静脉注射,PULSIOCATH,校正,经肺热稀释技术,3,弹丸注射,肺,PiCCO导管如：股动脉,经肺热稀释技术需要在中心静脉注射冷盐水(3.0,700850,850,700850,ELWI(ml/kg),GEDI(ml/m2)orITBI(ml/m2),CFI(1/min)orGEF(%),10,10,10,10,V+,V+!,V+!,V+,Cat,Cat,OK!,V-,700850,700-800850-1000,4.525,5.530,4.525,700-800850-1000,Cat,5.530,700850,700-800850-1000,700-800850-1000,10,10,10,10,V-,V+=增加容量(!=慎重),V-=减少容量,Cat=儿茶酚胺心血管药物,700850,10,OptimisetoSVV*(%),10,10,10,测量结果,目标,治疗,1.,2.,10,10,10,10,22,1.PiCCO技术的原理是什么？2.PiCCO的主要测量参数有哪些?3.PiCCO技术的临床应用诊断治疗树4.如何应用PiCCO技术？5.PiCCO技术有什么优点6.护理,23,PULSIOCATH动脉热稀释导管专门设计用于容量、血流动力监测，创伤小使用Seldinger穿刺技术（导丝穿刺技术）可以在病人体内保留10天以上注射液温度感受器固定仓（T型管）压力换能器任何常规中心静脉导管,耗材,24,连接,25,一旦改动病人住院号，日期时间或者病人相关信息，系统就会默认开始监测新的病人,如果对同一个病人进行监测,直接按.,开机，通过自检以后：,录入信息,Patient,Height,201000200,75.0kg,175cm,No,09.12.14:37,Newpatient?,PULSIONPiCCOplus,Weight,Lastpatientcalibrationat:,V5.2.2nonUS,1,2,2,1,26,把压力传感器和外界压力相通,按调零,.下个页面,压力调零,APZEROING,15mmHg,Zeroadjust,measuredAP,apply,0mmHg,1,2,3,先为PiCCO调零然后是床边监护调零！,27,输入菜单(I),为了计算index值，务必键入病人身高体重。,*更改此处的数值会删除所有之前的数据!,Patient,Weight,Height,Cathetertype,PV2015L20,Injectatetempsensor,Injectatetemperature,InjVol(min.15ml),CVP,RangePCCO,RangeAP,WarningPCCO,201000200,75.0kg,175cm,ACC:342,PV,24C,15ml,10mmHg,0.10l/min,60.160mmHg,0.2.8.6l/min,INPUT,*,4046,28,输入菜单(II),如果耗材连接正常，ACC（动脉导管常量）和InjectatetemperatureSensorHousing（注射液温度探头容纳管）会自动被识别,。,24C=室温水注射8C=冰水注射,Patient,Weight,Height,Cathetertype,PV2015L20,Injectatetempsensor,Injectatetemperature,InjVol(min.15ml),CVP,RangePCCO,RangeAP,WarningPCCO,201000200,75.0kg,175cm,ACC:342,PV,24C,15ml,10mmHg,0.10l/min,60.160mmHg,0.2.8.6l/min,INPUT,4046,29,最小推荐注射量会根据病人体重出现在括号里面(),参数可以可以通过按来更改被选中的参数可以通过按来更改数值,输入菜单(III),Patient,Weight,Height,Cathetertype,PV2015L20,Injectatetempsensor,Injectatetemperature,InjVol(min.15ml),CVP,RangePCCO,RangeAP,WarningPCCO,201000200,75.0kg,175cm,ACC:342,PV,24C,15ml,10mmHg,0.10l/min,60.160mmHg,0.2.8.6l/min,INPUT,4046,30,输入菜单(IV),当CVP的值改变5，则需要更新CVP值来精确的计算SVR,连续心输出量和动脉压显示的上下限范围,连续心输出量报警的上下限,Patient,Weight,Height,Cathetertype,PV2015L20,Injectatetempsensor,Injectatetemperature,InjVol(min.15ml),CVP,RangePCCO,RangeAP,WarningPCCO,201000200,75.0kg,175cm,ACC:342,PV,24C,15ml,10mmHg,0.10l/min,60.160mmHg,0.2.8.6l/min,INPUT,4046,31,主菜单,压力调零菜单,脉搏轮廓测量显示页,输入菜单,热稀释测量显示页,V5.2.2nonUS,PULSIONPiCCOplus,设置菜单,3,2,1,5,4,1,2,3,4,5,32,CONFIGURATION,Date,(changedeletespreviousresults),Parameter,selection,individual,Displayspan,ENG,5d,Loudness,Time,15:33,4,09.12.02,Language,ConfigureDisplay,(CVP),SVR,PVPI,(individual),SVV,SV,PPV/dPmx,GEF/CFI,TB,PPV/dPmx,GEF/CFI,ITBV/GEDV,on,dPmx,GEDV,on,on,on,on,on,on,on,CFI,个体参数设置:基本设置:最常用的参数作为默认显示个体选择:用户可以根据自己需要选择显示的参数(除了最关键的一些PiCCO参数),*如果更改了时间日期，病人相关数据会被删除，系统准备监测一个新的病人.,设置菜单参数选择,*,*,33,117,71,09.12.15:33TB37.0,AP,97,*.*,78,8%,1530,12,*,*,*,TIMESTCICFIGEDIELWI,MEAN,READYTI20,(CVP),PC,HR,SVI,*,*.*,*.*,*,SVRI,CI,SVV,dPmx,(GEDI),010s20s,热稀释测量显示页(I),2,按进行一次热稀释测量.,首先是基线测量，等出现“STABLE“,3,注射要稳而快，注射时间需要小于5秒钟.,010s20s,117,71,09.12.15:33TB37.0,AP,97,*.*,78,8%,1530,12,*,*,*,TIMESTCICFIGEDIELWI,MEAN,(CVP),PC,HR,SVI,*,*.*,*.*,*,SVRI,CI,SVV,dPmx,(GEDI),010s20s,INJECTIONTI20,201000200,201000200,2,3,1,1,34,按进行下一次热稀释测量,010s20s,010s20s,010s20s,117,71,09.1215:33TB37.0,AP,97,12,TIMESTCICFIGEDIELWI,T0.24/TI12,(CVP),(GEDI),SVRI,CI,HR,SVI,SVV,PPV,PC,2157,2.38,78,38,8%,12%,479,2.924.3479,11:492.924.37,7,010s20s,2,初始连续进行3次热稀释测量，对连续心输出量进行校准,3,.按到info页面,MEAN,*,201000200,479,1,1,2,3,不要忘记去输入菜单把注射水更改为8C,*如果EVLWI10ml/kg则推荐冰水注射.,热稀释测量显示页(II),35,010s20s,010s20s,010s20s,117,71,09.1215:33TB37.0,AP,97,12,TIMESTCIGEFGEDIELWI,15:29,T0.31/TI12,(CVP),(GEDI),0,2.96,24,480,8,SVRI,CI,HR,SVI,SVV,PPV,PC,2157,2.38,78,38,8%,12%,479,010s20s,010s20s,010s20s,010s20s,09.1215:33TB37.0,T0.31/TI12,0,2.81,26,450,8,07:03,0,3.06,24,474,8,07:05,3.16,26,489,8,0,11:56,0,3.22,26,496,8,11:58,2.90,25,475,7,11:59,0,3.24,26,509,8,15:05,0,2.92,24,15:06,3.15,25,502,8,15:29,2.96,24,480,8,MEAN,2.96,24,480,8,TIMESTCIGEFGEDIELWI,117,71,AP,97,12,(CVP),(GEDI),SVRI,CI,HR,SVI,SVV,PPV,PC,2157,2.38,78,38,8%,12%,479,07:02,按键还可以显示最近5次测量的曲线。,热稀释测量info页面,Info页面提供前50次热稀释测量情况的细节,201000200,201000200,0,0,0,520,6,1,2,2,1,删除一个有效的热稀释测量结果,先选中要删除的测量结果，再按功能键两次。,36,010s20s,010s20s,010s20s,09.1215:33TB37.0,TIMESTCICFIGEDIELWI,T0.31/TI12,15:0502.925.0489,11:5903.245.0450,15:0603.155.0520,15:292.96480,117,71,AP,97,12,(CVP),(GEDI),SVRI,CI,HR,SVI,SVV,dPmx,PC,2157,2.38,78,38,8%,1530,479,010s20s,热稀释测量所得最重要参数,连续心输出量(PCCO)(最近12秒钟的平均值),热稀释测量的参数值,连续参数,每搏量变异(SVV),ELWI=血管外肺水指数,CI=心指数,GEDI=全心舒张末期容积指数,CFI=心功能指数,2.965.0480,201000200,0,8,8,MW,8,8,8,5.0,或者GEF=全心射血分数,ITBI=胸腔内血容积指数,或者,37,010s20s,117,71,09.1215:33TB37.0,AP,97,12,(CVP),(GEDI),SVRI,CI,HR,SVI,SVV,PPV,PC,2157,2.38,78,38,8%,12%,479,AP,PCCI,6,20,20,160,脉搏轮廓测量显示页,连续心输出量(PCCO)的趋势图所显示的时间范围可以在设置页面(Configurationmenu)中更改(1小时5天),1h,0,201000200,.按到info页面,38,010s20s,117,71,09.1215:33TB37.0,AP,97,12,(CVP),(GEDI),SVRI,CI,HR,SVI,SVV,PPV,PC,2157,2.38,78,38,8%,12%,479,AP,PCCI,1h,6,20,20,160,0,010s20s,010s20s,010s20s,117,71,09.1215:33TB37.0,AP,97,2.38,78,8%,12%,12,2157,38,479,(ZVD),PC,CR,SVI,SVRI,HI,SVV,PPV,(GEDI),LastPCCOcalibration,160,0,AP,Info页面,按来获得最近一次对连续心输出量PCCO所作的校准信息,.病人正常值范围屏幕,201000200,201000200,1,2,2,1,39,117,71,09.1215:33TB37.0,AP,97,12,(CVP),(GEDI),SVRI,CI,SVI,SVV,dPmx,PC,2157,2.38,78,38,8%,1530,479,HR,.Normal,-Resultat15:30,10,8,6,4,2,0,42,26,18,10,3000,2400,1800,1200,600,0,20,16,12,8,4,0,50,Contractility,CFI,GEF,dPmx,SVV,010s20s,117,71,09.1215:33TB37.0,AP,97,12,(CVP),(GEDI),SVRI,CI,SVI,SVV,dPmx,PC,2157,2.38,78,38,8%,1530,479,HR,.Normal,-Resultat15:30,6.0,4.8,2.4,1.2,0.0,80,60,40,20,0.0,160,128,96,64,32,0.0,4000,3200,2400,1600,800,0.0,100,Output,Afterload,CI,SVI,MAP,SVRI,3.6,病人正常值范围屏幕(I),1.流量/后负荷,2.收缩力,显示最近一次校准后所的参数值,34,201000200,201000200,显示参数的正常范围,40,3.VolumeManagement,4.Lungs,.Normal,1200,1000,800,600,400,200,GEDI,71,09.1215:33TB37.0,AP,97,12,(CVP),(GEDI),SVRI,CI,SVI,SVV,dPmx,PC,2157,2.38,78,38,8%,1530,479,HR,-Resultat15:30,1250,1000,750,500,250,20,16,12,8,4,0,20,16,12,8,4,0,1500,VolumeManagement,ITBI,SVV,PPV,117,71,09.1215:33TB37.0,AD,97,12,(ZVD),(GEDI),SVRI,HI,SVI,SVV,dPmx,PC,2157,2.38,78,38,8%,1530,479,HR,.Normal,-Resultat15:30,4.0,3.0,2.0,1.0,0.0,5.0,Lungs,PVPI,20,15,10,5,0,ELWI,25,117,GEDI,1200,1000,600,800,400,200,201000200,201000200,.Normal,显示最近一次