文档介绍：PEEP 对心脏前负荷的影响北京协和医院杜斌病例摘要? WYG, M/51, 1629632 ? DOA: 2009/06/18 ? PMHx: HTN, DM ? CC: 发热, 皮疹 2月, 憋气 1月? Dx: ?肺间质病变原因待查?急性呼吸功能衰竭?休克病例摘要入 ICU 时?循环功能? HR 88 bpm ? NBP 84/58 mmHg ? CVP 16 mmHg ?呼吸机设置? FiO 2 ? PS 15 cmH 2O ? PEEP 20 cmH 2O CVP = 16 mmHg 能否除外低血容量是否需要输液提高前负荷 CVP = 16 mmHg 能否除外低血容量是否需要输液提高前负荷 CVP 与前负荷 RVEDV / RVEDP / RAP / CVP Cardiac Output 容量负荷反应组与无反应组的 CVP PEEP 对 CVP 的影响 Saner FH, Pavlakovic G, Gu Y, et al. Effects of positive end-expiratory pressure on systemic haemodynamics, with special interest to central venous mon iliac venous pressure in liver transplanted patients. Eur J Anaesth 2006; 23: 766-771 间断正压通气对心输出量的影响 Cournand A, Motley HL, Werko L, et al. Physiological studies of the effects of intermittent positive pressure breathing on cardiac output in man. Am J Physiol 1948; 152: 162-174. 心输出量下降心输出量下降右心室充盈受限静脉回流?胸腔内压(ITP) ?正压通气 PEEP 诱导的 CO 改变 CO = HR x SV CO = HR x SV CO = HR x SV SV 的影响因素前负荷前负荷心肌收缩力心肌收缩力后负荷后负荷 Viquerat CE, Righetti A, Suter PM: Biventricular volumes and function in patients with adult respiratory distress syndrome ventilated with PEEP. Chest 1983; 83: 509-514. 跨壁压的概念 5 cmH 2O 5 cmH 2O 20 cmH 2O 20 cmH 2O跨壁压的概念 5 cmH 2O 5 cmH 2O 20 cmH 2O 20 cmH 2O 15 cmH 2O