血流动力学监测与心脏超声.pptxVIP免费

指南解读：血流动力学监测与心脏超声（CUS）1.SLAX:肋下长轴切面2.SIVC:肋下下腔静脉切面3.PLAX：胸骨旁长轴切面4.PSAX:胸骨旁短轴切面5.A4CH:心尖四腔心切面CUS最常用的五个切面AntonelliM,etal.IntensiveCareMed.2007;33(4):575-90.CecconiM,etal.IntensiveCareMed.2014;40(12):1795-815.25位专家组成的团队12位专家组成的团队FiveSpecificQuestions(1)Whataretheepidemiologicandpathophysiologicfeaturesofshockintheintensivecareunit?(2)Shouldwemonitorpreloadandfluidresponsivenessinshock?(3)Howandwhenshouldwemonitorstrokevolumeorcardiacoutputinshock?(4)Whatmarkersoftheregionalandmicrocirculationcanbemonitored,andhowcancellularfunctionbeassessedinshock?(5)Whatistheevidenceforusinghemodynamicmonitoringtodirecttherapyinshock?2014ConsensusRecommendedagainst常规使用:(1)thepulmonaryarterycatheterinshock休克患者使用肺动脉导管(2)staticpreloadmeasurementsusedalonetopredictfluidresponsiveness仅仅使用静态的前负荷测量方法来预测液体反应性MaindifferencesBloodpressurestatementsICM2007ICM2014FluidresponsivenessstatementsICM2007ICM2014ClicktoaddTitleICM2007HemodynamicmonitoringICM2014ClicktoaddTitleCecconiM,etal.IntensiveCareMed.2014;40(12):1795-815.Mainnewstatements(1)Statementsonindividualizingbloodpressuretargets;(2)Statementsontheassessmentandpredictionoffluidresponsiveness;(3)Statementsontheuseofechocardiographyandhemodynamicmonitoring.2014ConsensusIdentificationofthetypeofshock•Werecommendfurtherhemodynamicassessment(suchasassessingcardiacfunction)todeterminethetypeofshockiftheclinicalexaminationdoesnotleadtoacleardiagnosis.BestpracticeWesuggestthat,whenhemodynamicassessmentisneeded,echocardiographyisthepreferredmodalitytoinitiallyevaluatethetypeofshockasopposedtomoreinvasivetechnologies.Recommendation.Level2;QoE(B)ClicktoaddTitleRationale:Contextanalysis(trauma,infection,chestpain,etc.)andclinicalevaluationwhichfocusesonskinperfusionandjugularveindistensionusuallyorientdiagnosistothetypeofshock,butcomplexsituationsmayexist(e.g.cardiactamponadeinapatientwithtraumaorsepticsh...