血流動力學監(jiān)測與心臟超聲

1、會計學1血流動力學監(jiān)測與心臟超聲血流動力學監(jiān)測與心臟超聲1.SLAX: 肋下長軸切面2.SIVC: 肋下下腔靜脈切面3.PLAX：胸骨旁長軸切面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位專家組成的團隊12位專家組成的團隊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的測量很迅速，即使是初學者，一般時間也小于3min；FOCUS應(yīng)當被列入重癥培訓的項目中去。Beraud AS, et al. Crit Care Med. 2013;41(8):e179-81.I

3、C-FoCUS 國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：聚焦心臟超聲（FoCUS）重點用于生命支持的評估、復蘇的評估等。Lheritier G, et al. Intensive Care Med. 2013;39(10):1734-42. 急性肺心病 ACP: RVEDA/LVEDA 0.6, 左室短軸可見室間隔矛盾運動卵圓孔未閉 PFO：左右心房之間可見右向左分流 結(jié)果：22.5%的機械通氣患者患ACP，15.5%的患

4、者患PFO，4.5%的患者同時患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測量心輸出量可以準確地識別出患者是否存在血容量不足以及能否獲益于補液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