17杨从山-ARDS与肺血管通透性PPT文档格式.ppt
- 文档编号:14808812
- 上传时间:2022-10-25
- 格式:PPT
- 页数:36
- 大小:5.34MB
17杨从山-ARDS与肺血管通透性PPT文档格式.ppt
《17杨从山-ARDS与肺血管通透性PPT文档格式.ppt》由会员分享,可在线阅读,更多相关《17杨从山-ARDS与肺血管通透性PPT文档格式.ppt(36页珍藏版)》请在冰豆网上搜索。
肺动脉肺动脉嵌顿压嵌顿压18mmHg,或无左心房压力增高的临床证据。
n急性肺损伤(ALI):
如PaO2/FiO2300mmHg且满足上述其它标准BernardGR,etal.TheAmerican-EuropeanConsensusConferenceonARDS.Definitions,mechanisms,relevantoutcomes,andclinicaltrialcoordination.AmJRespirCritCareMed,1994,149:
818PAWP18mmHgiscommonofARDSNEnglJMed,2006,354:
2213-24n29pats:
PAWP18mmHgn97%patswithPAWP18mmHghadanormalorelevatedcardiacindex.1001patients,513assignedtoPAC,488toCVCCVP/PAWP增高不一定就是左心衰增高不一定就是左心衰n高水平PEEP或气道平台压n针对休克的早期大量液体复苏n感染对心肌的抑制n腹内压的增高n肺血管阻力的增加(如COPD)n测量不当ARDS与心源性肺水肿的鉴别诊断与心源性肺水肿的鉴别诊断对于有基础心脏病史,合并感染、休克时鉴别诊断非常困难对于有基础心脏病史,合并感染、休克时鉴别诊断非常困难肺水肿机制HydrostaticpulmonaryedemapulmonaryoedemaPermeabilitypulmonaryedemaCardiogenicpulmonaryedema(CPE)ALI/ARDSThedefinitionofALI/ARDSshouldincludethefunctionalfeatureoflunginjury,i.e.anincreasedpulmonarymicrovascularpermeability.NormallungNEnglJMed,2005,353:
2788-96Starling定律与肺水肿定律与肺水肿nStarling公式公式Qf=K(Pmv-Ppmv)-(mv-Pmv)P=(Pmv-Ppmv)-(mv-Pmv)注:
Qf水分转移量;
K毛细血管滤过系数Pmv毛细血管内压;
Ppmv肺间质压蛋白质通过屏障系数mv毛细血管内胶体渗透压Pmv肺间质胶体渗透压P毛细血管内外静水压与胶体渗透压差肺泡毛细血管膜肺泡毛细血管膜ARDS液体和蛋白液体和蛋白肺血管通透性肺血管通透性(PVR)的测定的测定n伊文思蓝伊文思蓝(EBD)染料染料荧光比色法荧光比色法用于动物实验,它是经静脉注射伊文思蓝染料,30min后,开胸取出肺,用甲酸胺提取伊文蓝并用荧光光度计定量测定伊文思蓝含量,并通过伊文蓝甲酞胺溶液的荧光光谱和标准曲线来计算伊文思蓝含量来反映PVP肺血管通透性肺血管通透性(PVR)的测定的测定n双核素体内标记技术双核素体内标记技术(67Ga-labeledtransferrinand99mTc-labeledredbloodcells)IntensiveCareMed,2006,32(9):
1315-21nBALF蛋白含量(/血浆蛋白)nPiCCOCentralVenousCatheterArterialthermodilutioncatheterInjectatetemperaturesensorcablePCCIAP13.0316.28TB37.0AP14011792(CVP)5SVRI2762PCCI3.24HR78SVI42SVV5%dPmx1140(GEDI)625TemperatureinterfacecablePressurecablePiCCO反映肺水肿及通透性指标nExtravascularLungWater:
EVLWnPulmonaryVascularPermeabilityIndex:
PVPI(EVLW/PBV)PulmonaryVascularPermeabilityIndex(PVPI)HydrostaticpulmonaryedemaPermeabilitypulmonaryedemaPVPI=PBVEVLWnormalelevatedelevatedPVPI=PBVEVLWelevatedelevatednormalPVPI=PBVEVLWnormalnormalnormalPBVPBVPBVNormalLungnEVLW/ITBVKatzenelsonP,etal.CritCareMed,2004,32(7):
1550-4GroeneveldAB.IntensiveCareMed,2006,32(9):
1315-21nEVLWi/GEDViIntensiveCareMed,2000,26:
180-187IncreasedpulmonarycapillarypermeabilityandextravascularlungwateraftermajorvascularsurgerynSixteenmechanicallyventilatedpatientswithoutheartfailurewerestudied,within3haftermajorabdominalsurgery.nExtravascularlungwater,intrathoracic,globalend-diastolicandpulmonarybloodvolumes,67Ga-transferrinpulmonaryleakindexandventilatoryandradiographicvariablesnThepulmonaryleakindexwaselevatedin11patientsandasupranormalextravascularlungwaterwasassociatedwithahighpulmonaryleakindexEuropeanJournalofAnaesthesiology2006,23:
3641EuropeanJournalofAnaesthesiology2006,23:
3641AccuratecharacterizationofextravascularlungwaterinARDSDesign:
Prospective,observationalcohortstudySetting:
MedicalandsurgicalICUsattwoacademichospitalsCritCareMed2008;
36:
18031809IndexingEVLWtoPBWorAdjBWreducesthenumberofARDSpatientswithnormalEVLWCritCareMed2008;
18031809nDesign:
RetrospectivereviewofcasesnPatients:
48criticallyillpatsventilatedforARFBilateralinfiltratesonchestradiographPaO2/FiO2300mmHgEVLWI12ml/kgIntervention:
Pulmonarypermeability:
PVPIandEVLWi/GEDViCauseofpulmonaryedema:
determinedby3expertsMeasurementsandresults:
EVLWi/GEDVi3.01021.21021.41020.4102*PVPIcanbehelpfulfordistinguishinghydrostaticpulmonaryedemaandARDSCut-offvalue=3Se=85%Sp=100%ROC-PVPI:
0.920.04UnderlyingetiologiesofARDSpandARDSexpEurRespirJ,2003,22:
Suppl.42,48s56sDothedataobtainedbyPiCCOsystemenabletodifferentiatedirect/indirectALI/ARDS?
nTenpatients,fourwithdirectALI/ARDS(twoaspirationandtwopneumonia)andsixwithindirectALI/ARDS(sepsisinduced).Allpatientsweremechanicallyventilated.nOnehundredandtwentymeasurementswereavailableforanalysisCriticalCare2006,10(Suppl1):
P326PI(permeabilityindex)=EVLW/ITBVnConclusion:
EVLWIandPVPImonitoringisofclinicalvaluetosomedegreeinearlydiagnosisofhydrostaticpulmonaryedemaandpermeabilitypulmonaryedema.MaLJandQinYZ,ZhongguoWeiZhongBingJiJiuYiXue,2008;
20
(2):
111-4ComparisonofTwoFluid-ManagementStrategiesinAcuteLungInjuryNEnglJMed2006,354:
2564-75TheconservativestrategyoffluidmanagementisbetterNEnglJMed2006,354:
2564-75EVLWcorrelatedwellwithsurvival373criticallyillpatients,Retrospectiveanalysis.SakkaSG,etal.Chest2002,122:
20802086Extravascularlungwaterinsepsis-associatedARDSCritCareMed2008;
6973EVLWpisbetterforidentificationofnonsurvivorsAUCwere0.9880.019,0.8690.112,0.8510.113,and0.6430.137forEVLW
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 17 ARDS 血管 通透