脉搏指示连续心排血量技术在心脏前负荷测量的应用近况

监测心脏负荷变化对了解心脏功能具有十分重要的临床意义。中心静脉压(CVP)与右心前负荷虽存在一定关系,但不能完全反映左心前负荷。经动脉插管入左心房及肺动脉漂浮导管(Swan-Ganz导管)测量肺小动脉嵌顿压(PCWP)评估左心前负荷的方法,虽能为判断心脏前负荷提供较为可靠的依据,

Cardiac preload monitoring with pulse- induced contour cardiac output(PiCCO) technique

Cardiac preload is a very good index in reflecting cardiac function. End-diastolic volume indices determined by transpulmonary thermodilution(TDCOtp) and pulmonary artery thermodilution may give a better estimate of left ventricular preload than pulmonary capillary wedge pressure monitoring(PCWP) and central venous press(CVP). The PiCCO system (Pulse Contour Cardiac Output system; Pulsion Medical Systems, Munich, Germany) a newly available system, uses integrated transpulmonary thermodilution to measure the volumetric preload parameter global end-diastolic volume index (GEDVI) and includes the total volumes of cardiac atria and ventricles as well as part of the systemic vascular blood volume. Compared with conventional pressure-derived preload assessment, volumetric preload determination by the PiCCO system has been shown to better reflect left ventricular filling. The PiCCO system provides intermittent cardiac output(CO) assessment by TDCOtp, continuous CO measurement by pulse contour analysis (PCCO), and an estimation of intrathoracic blood volume (ITBV) from GEDV only by transpulmonary single indicator dilution, which should be a valuable parameter of cardiac preload.