协和杜斌血流动力学监测FocusonPICCO学习教案

1、会计学1第一页，共111页。Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrel FE Jr, Wagner D, Desbjens N, Goldman L, Wu AW, Califf RM, Fulkerson WJ Jr, Vidaillet H, Broste S, Bellamy P, Lynn J, Knaus WA. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT

2、Investigators. JAMA 1996; 276(11): 889-897 第1页/共110页第二页，共111页。第2页/共110页第三页，共111页。2000年年2001年年降低降低%出院患者数1,636,0461,684,089PAC使用数5,9695,02215.8PAC使用率(/1000)3.652.98年龄0 17岁2195765 74岁1,7391,37521 75岁1,9171,62015.5性别男性3,4922,97015女性2,4732,05217Appavu S, Cowen J, Bunyer M. The use of pulmonary artery cat

3、heterization has declined. Critical Care 2005; 9(Suppl 1): P69 (DOI 10.1186/cc3132)第3页/共110页第四页，共111页。2000年年2001年年降低降低%医院大医院87369620其他医院5,0924,32615地区Chicago39.4Rockford40St. Louis33.6中部15Appavu S, Cowen J, Bunyer M. The use of pulmonary artery catheterization has declined. Critical Care 2005; 9(Sup

4、pl 1): P69 (DOI 10.1186/cc3132)第4页/共110页第五页，共111页。Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553第5页/共110页第六页，共111页。0%20%40%60%PAWPCOSVRRAP预测准确性预测准确性Eise

5、nberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553第6页/共110页第七页，共111页。Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery cathe

6、terization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553第7页/共110页第八页，共111页。Eisenberg PR, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984

7、; 12(7): 549-553第8页/共110页第九页，共111页。Squara P, Fourquet E, Jacquet L, Broccard A, Uhlig T, Rhodes A, Bakker J, Perret C. A computer program for interpreting pulmonary artery catheterization data: results of the European HEMODYN resident study. Intensive Care Med 2003; 29: 735-741第9页/共110页第十页，共111页。不同意

8、见数目不同意见数目Kappa计算机辅助诊治前住院医生与计算机5.7 2.20.64 0.14*计算机辅助诊治后住院医生与计算机1.9 2.00.88 0.12住院医生与主治医生1.2 1.70.92 0.10主治医生与计算机0.9 1.20.95 0.07*p 0.05Squara P, Fourquet E, Jacquet L, Broccard A, Uhlig T, Rhodes A, Bakker J, Perret C. A computer program for interpreting pulmonary artery catheterization data: result

9、s of the European HEMODYN resident study. Intensive Care Med 2003; 29: 735-741第10页/共110页第十一页，共111页。计算机辅助前计算机辅助前计算机辅助后计算机辅助后RCRCRSSC酸碱失衡0.830.930.950.98机械通气0.780.950.960.98代谢0.520.860.900.96充盈状态0.560.840.910.93泵功能0.530.840.900.90循环0.720.910.940.96RC: 住院医生与计算机; RS: 住院医生与主治医生; SC: 主治医生与计算机Squara P, Fou

10、rquet E, Jacquet L, Broccard A, Uhlig T, Rhodes A, Bakker J, Perret C. A computer program for interpreting pulmonary artery catheterization data: results of the European HEMODYN resident study. Intensive Care Med 2003; 29: 735-741第11页/共110页第十二页，共111页。Squara P, Bennett D, Perret C. Chest 2002; 121: 2

11、009-2015第12页/共110页第十三页，共111页。Boldt J, Lenz M, Kumle B, Papsdorf M. Volume replacement strategies on intensive care units: results from a postal survey. Intensive Care Med 1998; 24: 147-151第13页/共110页第十四页，共111页。01015191915100预计预计(yj)PAWP (mmHg)测定测定(cdng)PAWP (mmHg)Eisenberg PL, Jaffe AS, Schuster DP.

12、Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553No change in planned therapy after catheterizationChange in planned therapy after catheterization第14页/共110页第十五页，共111页。00预计预计(yj)CO (L/min)测定测定(

13、cdng)CO (L/min)Eisenberg PL, Jaffe AS, Schuster DP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553第15页/共110页第十六页，共111页。Eisenberg PL, Jaffe AS, Schuster DP. Clinical evaluation compared to p

14、ulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med 1984; 12(7): 549-553参数参数判断正确数目判断正确数目/测定数目测定数目正确率正确率(%)PAWP31/10230CO49/9751SVR39/8844RAP54/9855第16页/共110页第十七页，共111页。Cardiac outputWedge pressureConnors(NEJM 83)ICU pts44% 42%Eisenberg(CCM 84)ICU p

15、ts50% 33%Bayliss(BMJ 83)CCU pts71% 62%第17页/共110页第十八页，共111页。第18页/共110页第十九页，共111页。Dawson NV et al. Hemodynamic assessment in managing the critically ill: is physician confidence warranted? Med Decis Making 1993; 13: 258-266第19页/共110页第二十页，共111页。Clinical SettingAccurate Assessment, %Unanticipated Change

16、s in Therapy Based on PAC, %Connors, et al62 noncardiac medical intensive care patients4848Eisenberg, et al103 critically ill patients5030Tuchschmidt and Sharma35 noncardiac medical intensive care patients 4265Steingrub, et al154 combined medical/surgical intensive care patients 5147Connors, et alCa

17、rdiac and noncardiac medical intensive care 6647第20页/共110页第二十一页，共111页。所有医生所有医生(n = 417)心内科医生心内科医生(n = 27)CO330 (79%)21 (75%)PAWP285 (68%)27 (100%)SvO2220 (53%)10 (38%)MPAP120 (37%)10 (38%)SV100 (24%)3 (13%)RAP20 (5%)RVEF20 (5%)RVEDV18 (4%)Squara P, Bennett D, Perret C. Chest 2002; 121: 2009-2015第21页

18、/共110页第二十二页，共111页。Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Groe J, Schirmer U. Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiologica Scandinavica 2007; 51(3):

19、 347-358.第22页/共110页第二十三页，共111页。血流动力学监测血流动力学监测比例比例(%)基本监测100肺动脉导管(PAC)58.2经食道超声(TEE)38.1PICCO13.0Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Groe J, Schirmer U. Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany:

20、results from a postal survey. Acta Anaesthesiologica Scandinavica 2007; 51(3): 347-358.第23页/共110页第二十四页，共111页。Esdaile B, Raobaikady R. Survey of cardiac output monitoring in intensive care units in England and Wales. Critical Care 2005; 9(Suppl 1): P68 (DOI 10.1186/cc3131)第24页/共110页第二十五页，共111页。Esdail

21、e B, Raobaikady R. Survey of cardiac output monitoring in intensive care units in England and Wales. Critical Care 2005; 9(Suppl 1): P68 (DOI 10.1186/cc3131)第25页/共110页第二十六页，共111页。第26页/共110页第二十七页，共111页。Morris AH, Chapman RH, Gardner RM. Frequency of technical problems encountered in the measurement o

22、f pulmonary artery wedge pressure. Crit Care Med 1984; 12(3): 164-170N (%) measurements% of technical problemsNo problem1868 (69)Technical problems843 (31)Criterion 1 (total)(12)(38)Unable to obtain an “atrial waveform”1238Criterion 2 (total)156 (6)19WP waveform intermediate between the phasic PA an

23、d atrial waveforms100 (4)12Spontaneous variation of WP56 (2)7Criterion 3 (total)381 (14)45Poor dynamic response184 (7)22Damped tracing65 (2)8Overinflation42 (2)5Cannot aspirate blood with the catheter in the PA36 (1)4Cannot aspirate blood with the catheter in the wedge position54 (2)6第27页/共110页第二十八页

24、，共111页。Morris AH, Chapman RH, Gardner RM. Frequency of technical problems encountered in the measurement of pulmonary artery wedge pressure. Crit Care Med 1984; 12(3): 164-170WPTechnical ProblemCorrected byInitialConfirmed228OverinflationDeflated balloon812Venous bloodAdvance 2 cm308Venous bloodWith

25、drawn156Venous bloodNothing812Poor dynamic responseWithdrawn 4 cm248Poor dynamic responseDeflated and inflated balloon2313Poor dynamic responseWithdrawn128Poor dynamic responseFlushed3618Partial WPPatient coughed214Partial WPRepositioned720Partial WPNothing1420?RepositionedWP initial WP confirmed =

26、11 6 mmHgRange (-13, +22)第28页/共110页第二十九页，共111页。Morris AH, Chapman RH, Gardner RM. Frequency of wedge pressure errors in the ICU. Crit Care Med 1985; 13(9): 705-708ProblemDescriptionsNumber (%)Damped tracingReduced high-frequency content40 (43%)Poor dynamic responseAbsent oscillation, low frequency,

27、or inadequate duration of oscillations after a sudden pressure decrease from approximately 300 mmHg to vascular levels58 (62%)Over inflationSlow, frequently linear increase in pressure after balloon inflation10 (9%)Partial WPWaveform intermediate between phasic PA and atrial waveforms22 (25%)第29页/共1

28、10页第三十页，共111页。Distribution of WP measurements and frequency of a WP error 4 mmHgTrauma ICURespiratory ICUN% (95%CI)N% (95%CI)Total WP attempts10917% (11 26%)17710% (6 15%)WP ultimately confirmed80158Initial WP without technical problems468% (3 16%)1334% (1 8%)Initial WP with technical problems5326%

29、(18 44%)4031% (17 47%)No WP obtained104Morris AH, Chapman RH, Gardner RM. Frequency of wedge pressure errors in the ICU. Crit Care Med 1985; 13(9): 705-708第30页/共110页第三十一页，共111页。Gnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside

30、: time to act? Crit Care Med 1997; 25: 213-220第31页/共110页第三十二页，共111页。Gnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220PAC相关知识调查问卷的内容分类1压力或心输出量测定的技术问题2相关指标的计算3血流动力学指标的解读4留置导管5导管相关并发症

31、的识别, 预防及治疗6应用PAC指导治疗7其他第32页/共110页第三十三页，共111页。In-TrainingPostgraduate Training CompletedPrimary Medical SpecialtyAnesthesiology69.9 13.777.0 12.6Internal Medicine67.9 14.378.3 11.5Others62.4 16.369.8 15.2Opinion of Respondents on Their Knowledge of PACsInadequate57.6 15.355.0 17.3Minimal65.7 14.371.9

32、 14.1Adequate73.2 13.179.2 10.7Superfluous-83.3 0Gnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220第33页/共110页第三十四页，共111页。60.665.46977.380.874.373.878.283.378.95060708090Never 10/mth

33、Inserting PACs: Frequency in the Last 6 MthsMean ScoresIn-TrainingPostgraduate Training CompletedGnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220第34页/共110页第三十五页，共111页。55.862.667.9

34、71.173.663.970.275.279.581.95060708090Never 10/mthUsing PAC Data for Guiding Therapy: Frequency in the Last 6 MthsMean ScoresIn-TrainingPostgraduate Training CompletedGnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowledge of right-heart catheterization at the bedside: time to

35、act? Crit Care Med 1997; 25: 213-220第35页/共110页第三十六页，共111页。63.470.975.977.473.367.67379.979.678.85060708090Never 10/mthSupervising PAC Insertion: Frequency in the Last 6 MthsMean ScoresIn-TrainingPostgraduate Training CompletedGnaegi A, Feihl F, Perret C. Intensive care physicians insufficient knowle

36、dge of right-heart catheterization at the bedside: time to act? Crit Care Med 1997; 25: 213-220第36页/共110页第三十七页，共111页。第37页/共110页第三十八页，共111页。Central venous catheterInjectate temperature sensor housing PV4046 Arterial thermodilution catheter Injectate temperature sensor cablePC80109 PULSION disposable

37、pressure transducer PV8115PCCIAP AP 140117 92(CVP) 5SVRI 2762PCHR 78SVI 42SVV 5%dPmx 1140(GEDI) 625 DPT Monitor cablePMK-206Interface cablePC80150 Connection cableto bedside monitorPMK - XXX AUX adaptercable PC81200 第38页/共110页第三十九页，共111页。a. 经肺热稀释技术经肺热稀释技术b. 动脉脉搏轮廓分析技术动脉脉搏轮廓分析技术第39页/共110页第四十页，共111页。T

38、b注射注射t第40页/共110页第四十一页，共111页。中心中心(zhngxn)(zhngxn)静静脉注射脉注射右心右心左心左心肺肺PiCCO导导管如插在管如插在股动脉内股动脉内第41页/共110页第四十二页，共111页。PCCO动脉热稀释动脉热稀释测量位置测量位置静脉注射静脉注射RAEDVPBVEVLWLAEDVLVEDVEVLWRVEDV常规热稀释常规热稀释测量位置测量位置s010203040500,00,20,40,6 C- -D DT注射注射热热稀稀释释测测量量曲曲线线D-dtTKV)T(TCObiibTDa Tb = 血流温度血流温度Ti = 注射指示剂温度注射指示剂温度Vi = 注

39、射指示剂容积注射指示剂容积 Tb . dt = 热稀释曲线下面积热稀释曲线下面积K = 校正系数校正系数第42页/共110页第四十三页，共111页。t sP mm HgSV第43页/共110页第四十四页，共111页。压力压力(yl)曲曲线下面积线下面积压力压力(yl)曲曲线型状线型状PCCO = cal HR SystoleP(t)SVR+ C(p) dPdt() dt动脉顺应性动脉顺应性参数参数心心率率与病人有关的校正与病人有关的校正因子因子 t sP mm HgPCCO is displayed as last 12s mean第44页/共110页第四十五页，共111页。AuthorPt/

40、ObsCOTDa COTDpaBias SDrVon Spiegel, et al. Anaesthesist 1996; 45(11)21/48-4.7 1.5%.97McLuckie, et al. Acta Paediatr 1996; 859/?0.19 0.21 L/min/m2Goedje, et al. Chest 1998; 113(4)30/1500.16 0.31 L/min/m2.96Goedje, et al. Thorac Cardiovasc Surg 1998; 4630/8100.26 0.71 L/min.96Zoolner, et al. Anaesthes

41、ist 1998; 47(11)18/1600.03 1.04 L/min.91Goedje, et al. Crit Care Med 1999; 27(11)24/216-0.29 0.66 L/min.93Sakka, et al. Intensive Care Med 1999; 2537/4490.68 0.62 L/min.97Sakka, et al. J Cardiothorac Vasc Anesth 2000; 14(2)12/510.73 0.38 L/min.96Zoolner, et al. J Cardiothorac Vasc Anesth 2000; 14(2)

42、19/760.21 0.73 L/min.96Bindels, et al. Crit Care 2000; 445/2830.49 0.45 L/min/m2.95第45页/共110页第四十六页，共111页。a. 经肺热稀释技术经肺热稀释技术b. 动脉脉搏轮廓分析技术动脉脉搏轮廓分析技术第46页/共110页第四十七页，共111页。ln c (I)注射注射At再循环再循环MTtte-1DStc (I)第47页/共110页第四十八页，共111页。第48页/共110页第四十九页，共111页。第49页/共110页第五十页，共111页。第50页/共110页第五十一页，共111页。ln c (I)注射注

43、射(zhsh)At再循环的影响再循环的影响(yngxing)MTtte-1DStc (I)MTt: Mean transit time平均传输时间平均传输时间 half of the indicator passed the point of detection DSt: Downslope time下降时间下降时间 exponential downslope time of TD curve第51页/共110页第五十二页，共111页。Vall = V1 + V2 + V3 + V4 = MTt x FlowMeier et al. J Appl Physiol. 1954V3 = 最大腔的容

44、积最大腔的容积(rngj) = DSt x FlowNewman et al. Circulation. 1951指示剂由注射点到检测点的平均传输时间指示剂由注射点到检测点的平均传输时间(shjin)MTt由两点间的总容积决定由两点间的总容积决定下降时间下降时间DSt由其中最大的腔室决定由其中最大的腔室决定 (比其它腔至少大比其它腔至少大 20% 成立成立!)flowV3V4V2V1注射注射检测检测第52页/共110页第五十三页，共111页。GEDVPTVRAEDVPBVLAEDVLVEDVRVEDVEVLWEVLWITTVPTV = 肺内热容积肺内热容积, 在一系列混合腔室中具有在一系列混合

45、腔室中具有(jyu)最大的热容积最大的热容积 (DSt 容容积积)ITTV = 胸腔内总热容积胸腔内总热容积, 从注射点到测量的热容积之和从注射点到测量的热容积之和 (MTt 容积容积)GEDV= 全心舒张末期容积全心舒张末期容积 = ITTV PTV第53页/共110页第五十四页，共111页。RAEDVPTVLAEDVLVEDVRVEDV胸腔胸腔(xingqing)总热容积总热容积(ITTV)ITTV = CO x MTtTDa肺内总热容积肺内总热容积(rngj)(PTV)PTV = CO x DStTDa全心舒张末期容积全心舒张末期容积GEDV = ITTV PTVRAEDVRVEDVLA

46、EDVLVEDVRAEDVRVEDVLAEDVLVEDVPTVPTV第54页/共110页第五十五页，共111页。Sakka et al, Intensive Care Med 2000; 26: 180-187ITBV = 1.25 * GEDV 28.4 mlITBVTD (ml)GEDVST (ml)GEDV vs. ITBV in 57 intensive care patients第55页/共110页第五十六页，共111页。Sakka et al, Intensive Care Med 26: 180-187, 2000n = 209Bias = -7.6 ml/m2SD = 57.4

47、 ml/m2ITBVIST vs. ITBVITD in 209 intensive care patients第56页/共110页第五十七页，共111页。ITTV = CO x MTtTDaPTV = CO x DStTDaITBV = 1.25 x GEDVGEDV = ITTV PTVRAEDVRVEDVLAEDVLVEDVRAEDVRVEDVLAEDVLVEDVPBVRAEDVRVEDVLAEDVLVEDVPTVPTV第57页/共110页第五十八页，共111页。第58页/共110页第五十九页，共111页。第59页/共110页第六十页，共111页。PAOP (mmHg)有反应者有反应者无

48、反应者无反应者Calvin et al8 17 2Schneider et al10 110 1Reuse et al10 410 3Diebel et al14 77 2 Diebel et al16 615 5Wagner and Leatherman10 314 4 Tavernier et al10 412 3Tousignant et al12 316 3 Michard et al10 311 2第60页/共110页第六十一页，共111页。第61页/共110页第六十二页，共111页。LVEDA (cm2/m2)有反应者有反应者无反应者无反应者Tavernier et al9 312

49、 4 Tousignant et al15 520 5 Feissel et al10 410 2第62页/共110页第六十三页，共111页。 Lichtwarck-Aschoff et al, Intensive Care Med 1992; 18: 142-147第63页/共110页第六十四页，共111页。 Lichtwarck-Aschoff et al, Intensive Care Med 1992; 18: 142-147第64页/共110页第六十五页，共111页。1. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Leca

50、rpentier Y, Richard C, Pinsky MR, Teboul JL. Relation between Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness in Septic Patients with Acute Circulatory Failure. Am J Respir Crit Care Med 2000; 162: 134-138. 2. Rex S, Brose S, Metzelder S, Huneke R, Schalte G, Autschbach R, Ro

51、ssaint R, Buhre W. Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth 2004; 93: 782-788第65页/共110页第六十六页，共111页。所有患者所有患者单一患者单一患者相关系数相关系数, rD DSVIartD DCIartD DCIart (最低值最低值 最高值最高值)DCVP-0.090.00-0.01 0.33DPAWP-0.02-0.01-0.36 0.03DRAEDVI0.28-0.11-0.02 0.37DRVEDVI0.03-0.02

52、0.02 0.03DITBVI0.760.830.67 0.91DGEDVI0.820.870.70 0.93Goedje et al, Eur J Cardiothorac Surg 1998; 13 (5): 533-539;discussion 539-540第66页/共110页第六十七页，共111页。第67页/共110页第六十八页，共111页。第68页/共110页第六十九页，共111页。Sensitivity 1 Specificity Berkenstadt et al, Anesth Analg 2001; 92: 984-989- - - CVP_ SVV 第69页/共110页第

53、七十页，共111页。第70页/共110页第七十一页，共111页。Scillia P, Delcroix M, Lejeune P, Melot C, Struyven J, Naeije R, Gevenois PA. Hydrostatic pulmonary edema: evaluation with thin-section CT in dogs. Radiology 1999; 211: 161-168第71页/共110页第七十二页，共111页。Martin GS, Eaton S, Mealer M, Moss M. Extravascular lung water in pati

54、ents with severe sepsis: a prospective cohort study. Crit Care 2005; 9: R74-R82 (DOI 10.1186/cc3025)第72页/共110页第七十三页，共111页。Sturm, In: Practical Applications of Fiberoptics in Critical Care Monitoring, Springer Verlag Berlin - Heidelberg - NewYork 1990, pp 129-139第73页/共110页第七十四页，共111页。第74页/共110页第七十五页，

55、共111页。ITTV = CO x MTtTDaPTV = CO x DStTDaITBV = 1.25 x GEDVEVLW = ITTV ITBVGEDV = ITTV PTVRAEDVRVEDVLAEDVLVEDVRAEDVRVEDVLAEDVLVEDVPBVRAEDVRVEDVLAEDVLVEDVPTVPTVEVLWEVLW第75页/共110页第七十六页，共111页。Sturm, In: Practical Applications of Fiberoptics in Critical Care Monitoring, Springer Verlag Berlin - Heidelbe

56、rg - NewYork 1990, pp 129-139第76页/共110页第七十七页，共111页。Sakka et al, Intensive Care Med 26: 180-187, 2000Bias = -0.2 ml/kgSD = 1.4 ml/kgn = 209EVLWIST vs. EVLWITD in 209 intensive care patients第77页/共110页第七十八页，共111页。Mitchell et al, Am Rev Resp Dis 145: 990-998, 1992第78页/共110页第七十九页，共111页。第79页/共110页第八十页，共11

57、1页。指标指标EVLW增加增加临床症状100 200%胸片100 200%氧合(机械通气时)300%EVLW (PiCCO)10 15%第80页/共110页第八十一页，共111页。Morisawa K, Taira Y, Takahashi H, Matsui K, Ouchi M, Fujinawa N, Noda K. Do the data obtained by the PiCCO system enable one to differentiate between direct ALI/ARDS and indirect ALI/ARDS? Critical Care 2006, 1

58、0(Suppl 1):P326 (doi: 10.1186/cc4673)第81页/共110页第八十二页，共111页。Morisawa K, Taira Y, Takahashi H, Matsui K, Ouchi M, Fujinawa N, Noda K. Do the data obtained by the PiCCO system enable one to differentiate between direct ALI/ARDS and indirect ALI/ARDS? Critical Care 2006, 10(Suppl 1):P326 (doi: 10.1186/c

59、c4673)直接直接ARDS/ALI间接间接ARDS/ALIP值值ITBVI984 331.71279 312.10.0001EVLWI13.2 4.716.8 6.50.014PVPI0.59 0.270.44 0.220.006第82页/共110页第八十三页，共111页。PVPISIRS组(n = 31)2.37 1.0ARDS组(n = 13)3.2 1.10非ARDS组(n = 18)1.7 0.44非SIRS组(n = 10)1.2 0.21Tagami T, Kushimoto S, Atsumi T, Matsuda K, Miyazaki Y, Oyama R, Koido Y

60、, Kawai M, Yokota H, Yamamoto Y. Investigation of the pulmonary vascular permeability index and extravascular lung water in patients with SIRS and ARDS under the PiCCO system. Critical Care 2006; 10(Suppl 1): P352 (doi: 10.1186/cc4699)第83页/共110页第八十四页，共111页。第84页/共110页第八十五页，共111页。第85页/共110页第八十六页，共111页