血流動(dòng)力學(xué)監(jiān)測(cè)與心臟超聲

1、會(huì)計(jì)學(xué)1血流動(dòng)力學(xué)監(jiān)測(cè)與心臟超聲血流動(dòng)力學(xué)監(jiān)測(cè)與心臟超聲1.SLAX: 肋下長(zhǎng)軸切面2.SIVC: 肋下下腔靜脈切面3.PLAX：胸骨旁長(zhǎng)軸切面4.PSAX: 胸骨旁短軸切面5.A4CH: 心尖四腔心切面Antonelli M, et al. Intensive Care Med. 2007;33(4):575-90.Cecconi M, et al. Intensive Care Med. 2014;40(12):1795-815. 25位專家組成的團(tuán)隊(duì)12位專家組成的團(tuán)隊(duì)n(5) What is the evidence for using hemodynamic monitoring t

2、o direct therapy in shock?ICM 2007ICM 2014ICM 2007ICM 2014ICM 2007ICM 2014Cecconi M, et al. Intensive Care Med. 2014;40(12):1795-815. Vincent JL, et al. N Engl J Med. 2013;369(18):1726-34. 梗阻性心包填塞FOCUS的測(cè)量很迅速，即使是初學(xué)者，一般時(shí)間也小于3min；FOCUS應(yīng)當(dāng)被列入重癥培訓(xùn)的項(xiàng)目中去。Beraud AS, et al. Crit Care Med. 2013;41(8):e179-81.I

3、C-FoCUS 國(guó)際聚焦心臟超聲循證建議Via G, et al. Journal of the American Society of Echocardiography. 2014;27(7):683 e1- e33.名稱確認(rèn)：聚焦心臟超聲（FoCUS）重點(diǎn)用于生命支持的評(píng)估、復(fù)蘇的評(píng)估等。Lheritier G, et al. Intensive Care Med. 2013;39(10):1734-42. 急性肺心病 ACP: RVEDA/LVEDA 0.6, 左室短軸可見(jiàn)室間隔矛盾運(yùn)動(dòng)卵圓孔未閉 PFO：左右心房之間可見(jiàn)右向左分流 結(jié)果：22.5%的機(jī)械通氣患者患ACP，15.5%的患

4、者患PFO，4.5%的患者同時(shí)患ACP和PFO。Shock and Hemodynamic InstabilityEstimating CVP, Diagnosing Hypovolemia, and Predicting Fluid Responsivenessshock subjectcontrol subject Yanagawa Y, et al. J Trauma. 2005;58(4):825-9. IVC的直徑與創(chuàng)傷患者的低血容量相關(guān)在懷疑血容量不足的自主呼吸患者中，在PLR前后使用FoCUS測(cè)量心輸出量可以準(zhǔn)確地識(shí)別出患者是否存在血容量不足以及能否獲益于補(bǔ)液Maizel J,

5、et al. Intensive Care Med. 2007;33(7):1133-8. Preau S, et al. Crit Care Med. 2010;38(3):819-25. Change (%) =100%* (post-VE value baseline 2 value)/baseline 2 value. Respond: change 15%PLR, passive leg raising; VE, volume expansionPP, radial pulse pressure; SV, stroke volume; VF, peak velocity of femoral artery flown(5) What is the evidence for using hemodynamic monitoring to direct therapy i