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1、,Philips PiCCO 模块操作,2,PULSION disposable pressure transducer PiCCO Monitoring Kit PV8115,Central venous catheter,PULSIOCATH Arterial Thermodilution Catheter e.g.PV2015L20,Temperature interface cable M1643A,Injectate-temperature sensor cableM1646A(Philips)*PC80109(PULSION)*,Injectate-temperature sens
2、or housingPV4046(included in PV8115),PULSIONPMK-206,PRESS,PRESS,0,PICCO,C.O.,CCO/C.O,Start,PICCO,3,无病人,成人,27 Dec 10:46,监护仪设置,SVR,AudioOff,静音,暂停报警,主设定,MainScreen,Graph Trends,较 零,压力归零,2,2,在屏幕上点击需校零的波形，按“压力归零”键,将压力换能器和大气相连通,1,ABPSys.,120/70(91),Pulse,60,ABP,1,有创压力波形校零,4,无病人,成人,27 Apr 10:45,AudioOff,静音
3、,暂停报警,主设定,主屏幕,无病人,病人类别:成人,起博器:否,儿童,新生儿,成人,病人类别,点击“无病人”输入“病人类别”点击“收入病人”,Graph Trends,输入病人统计,1,2,1,2,ABP,ABPSys.,120/70(91),Pulse,60,SVR,病人统计,?,监护仪设置,病人信息统计,收入病人,3,3,5,无病人,成人,27 Dec 10:45,C.O./CCO,监护仪设置,AudioOff,静音,报警暂停,主设定,主屏幕,ABPSys.,120/70(91),Pulse,60,SVR,?,CCO,CCI,SV,SVV,C.I.,HR,RR,ITBV,ITBVI,GED
4、V,GEDVI,C.O.,CFI,8.54.0,姓:,名:,医疗记录号:,CVP-,出生日期:,性别:,年龄:,身高:,体重:,输入病人统计,Graph Trends,输入病人统计,确认,病人类别.:,起搏:,姓,姓,Smi,Back,q,w,e,r,t,y,u,i,o,p,(,),Clr,a,s,d,f,g,h,j,k,l,:,Lock,z,x,c,v,b,n,m,?,Enter,Shift,Alt,1,2,3,取消,输入病人“姓”按键确认,1,2,输入病人“名”，并输入“医疗记录号”,3,病人信息统计,6,Smith,David,成人,27 Dec 10:45,C.O./CCO,监护仪设置
5、,AudioOff,主屏幕,ABP,ABPSys.,120/70(91),Pulse,60,SVR,?,CCO,CCI,SV,SVV,HR,RR,8.54.0,姓:Smith,名:David,出生日期:,性别:,年龄:,Graph Trends,Patient Demographics,病人类别:成人,起搏:否,身高:180,体重,7,8,9,4,5,6,1,2,3,.,-,0,Enter,Back,85,kg,2,体重:,1,3,输入病人“身高”“体重”按 确认按“确认”储存信息,1,2,3,病人信息统计,输入病人统计,主设定,确认,取消,报警暂停,静音,医疗记录号:,7,无病人,成人,27
6、 Dec 10:46,监护仪设置,SVR,AudioOff,静音,暂停报警,主设定,MainScreen,Graph Trends,较 零,压力归零,1,根据需要，点击屏幕右下空白处，选择在屏幕上显示的参数。,ABPSys.,120/70(91),Pulse,60,ABP,1,有创压力波形校零,ITBV,？,？,更改数值,SVVCOCIITBVEVLWEVLWIGEDV,血温,37.0,8,Note:The function buttons at the lower edge of the monitor can be configurated freely by PHILIPS Medica
7、l Systems,设定C.O.界面，测量方法，导管型号会自动识别（正确连接后）,1,2,Smith,David,成人,27 Dec 10:45,监护仪设置,AudioOff,主设定,主屏幕,ABPSys.,120/70(91),Pulse,60,SVR,?,CCO,CCI,SV,SVV,HR,RR,C.O.,8.54.0,Last Name:Smith,First Name:David,MRN:101010,CVP-,Age:,C.I.,ITBV,ITBVI,GEDV,GEDVI,CFI,ABP,CVP-,设定 C.O.,方法:经肺,Tinj Probe Type:M1646,C.O.:on
8、,Tblood HighLimit:on,Tblood Low Limit:on,Alarms:on,Temperature Unit:,CardiacOutput,Wedge,Calcs,Graph Trends,RelearnArrhy,DelayedRecord,静音,暂停报警,心输入量,1,1,选择“心输出量”，进入热稀释测量界面,9,PauseAlarms,ABPSys.,120/70(91),Pulse,60,CCO,CCI,SV,SVV,HR,8.54.0,Last Name:Smith,First Name:David,CVP-,ABP,CVP-,ABPSys.,120/70(
9、91),Pulse,60,SVR,HZV,Last Name:Smith,First Name:David,CVP-,Age:,HI,ITBV,ITBVI,GEDV,GEDVI,CFI,CVP-,心输出量(经肺),TBlut 37.0,#1,CathCt,InjVol,C.I.IBSA,C.I.,341,10 ml,37.0,36.9.,36.8.,Tblood 37.0,TrialCCO-Cal,C.O.CFIC.I.ITBVIEVLWIETVIGEDVI,Ready for new measurement,AudioOff,静音,报警暂停,No measurement done,Table
10、Contents,0,3 C,平均,经肺热稀释测量,主设定,主屏幕,按“开始心输出量监测”基线提示稳定后注入冰水,1,1,Smith,David,成人,27 Dec 10:46,监护仪设置,开始心输出量监测,2,2,所需注入冰水量会根据病人身高体重提示,注射需快而稳（7秒）！,单位,10,PauseAlarms,37.0,SVV,HR,ABP,SelectTrial,AudioOff,静音,报警暂停,Table Contents,主设定,主屏幕,ABPSys.,120/70(91),Pulse,60,Last Name:Smith,CVP-,CVP-,ABPSys.,120/70(91),Pu
11、lse,60,Last Name:Smith,First Name:David,CVP-,CVP-,ABPSys.,120/70(91),Pulse,60,SVR,Last Name:Smith,First Name:David,CVP-,Age:,CVP-,Tblood 37.0,CathCt,InjVol,C.I.BSA,C.O.,341,10 ml,37.0,36.9.,36.8.,Tblood 37.0,Ready for new measurement,2019181716151413121110,按“注射液容量”可以根据不同病人情况自行修改注射容量(最大值不超过.20 ml),1,
12、1,CCO,CCI,8.54.0,C.O.CFIC.I.ITBVIEVLWITinjGEDVI,SV,TrialCCO-Cal,InjVol,0,3 C,Smith,David,成人,27 Dec 10:46,监护仪设置,心输出量(经肺),经肺热稀释测量,11,Last Name:Smith,TrialkHZV-Cal,#1Kal,CCO,CCI,SV,SVV,HR,C.O.,8.54.0,C.I.,ITBV,ITBVI,GEDV,GEDVI,CFI,ABP,AudioOff,ABPSys.,120/70(91),Pulse,60,Last Name:Smith,CVP-,CVP-,ABPSy
13、s.,120/70(91),Pulse,60,Last Name:Smith,First Name:David,CVP-,CVP-,ABPSys.,120/70(91),Pulse,60,SVR,Last Name:Smith,First Name:David,CVP-,Age:,CVP-,Tblood 37.0,#2,CathCt,InjVol,C.I.2.75BSA 2.05,C.O.5.63,341,15 ml,37.0,36.9.,36.8.,Tblood 37.0,Injection detected,C.O.CFIC.I.ITBVIEVLWITinjGEDVI,Stop C.O.,
14、Table Contents,主设定,主屏幕,#1Cal,0,3 C,Average,Unit,l/min1/minl/min/m2ml/m2ml/kg0Cml/m2,*,5.464.92.75671719537,5.554.952.756797543,5.635.02.75686720549,#2Cal,*,Smith,David,成人,27 Dec 10:48,监护仪设置,TrialCCO-Cal,经肺热稀释测量,心输出量(经肺),.进行热稀释探测期间不能进行下一次注射冰水.初次及每隔8小时，需连续打三次冰水，获得CO平均值，校准CCO,静音,报警暂停,开始心输出量监测,保存C.O.校准C
15、CO,12,Last Name:Smith,TrialkHZV-Cal,#1Kal,Tblood,37.0,SV,SVV,HR,ITBVI,GEDV,GEDVI,CFI,ABP,ABPSys.,120/70(91),Pulse,60,CVP-,ABPSys.,120/70(91),Pulse,60,CVP-,ABPSys.,120/70(91),Pulse,60,SVR,Age:,CVP-,Cardiac Output(transpulmonary),Tblood 37.0,#3,CathCt,InjVol,C.I.2.65BSA 2.05,C.O.5.44,341,15 ml,37.0,36
16、.9.,36.8.,Tblood 37.0,Ready for new measurement,按“保存C.O.校准CCO”键，对动脉压力波形进行校准并保存,1,2,CCO,CCI,8.54.0,C.O.CFIC.I.ITBVIEVLWITinjGEDVI,#1Cal,5.464.92.75671719537,5.635.02.75686720549,#2Cal,5.444.92.65669716535,#3Cal,1,C.O.,C.I.,ITBV,l/min1/minl/min/m2ml/m2ml/kg0Cml/m2,5.514.92.726757540,Average,Unit,0,3 C
17、,排除数据收到干扰的热稀释曲线，高亮需排除的曲线按“拒绝接受”键,Smith,David,成人,27 Dec 10:48,监护仪设置,TrialCCO-Cal,AudioOff,Stop C.O.,Table Contents,2,Average values stored and CCO calibrated at 10:48,经肺热稀释测量,保存C.O.校准CCO,开始心输出量监测,报警暂停,静音,主设定,主屏幕,接收拒绝,1,血液动力学计算,3,3,按“血液动力学计算”键，进入计算页面,13,首先“采样生命体征”“并进行计算”,ABPSys.,120/70(91),Puls,60,Tbl
18、ood,37.0,CCO,CCI,SV,SVV,HR,C.O.,8.54.0,Last Name:Smith,First Name:David,MRN:101010,Age:,C.I.,ITBV,ITBVI,GEDV,GEDVI,CFI,AudioOff,静音,报警暂停,主屏幕,SVR,计算,进行计算,HemoReview,TableContents,Calculations,采样生命体征,On/OffDateTime,PrintCalc,Calc Type,血液动力计算,27 Dec 10:50,Calc Time,5.51,120,70,91,180,85,Input Units,Outp
19、ut Units,Indexed Units,C.O.HRABPsABPdABPmEVLWITBVGEDVCVPHeightWeight,60,SV 72 SVR 1480 BSA 2,05,l/min/minmmHgmmHgmmHgml/kgmlmlmmHgcmkg,mlDS/cm-5,C.I.2.7SI 47SVRI 2960,l/min/m2ml/m2DSm2/cm-5,血流动力学计算,9,按“CVP”，手动输入CVP值,1,2,1,2,1384,1107,595,3,3,Smith,David,成人,27 Dec 10:50,监护仪设置,主设定,14,PiCCO 参数正常值,参数 正常
20、值 单位CI(心指数)3.0 5.0 l/min/m2SVI（每搏量指数）40 60 ml/m2 GEDI（全心舒张末期容积指数）680 800 ml/m2ITBI（胸腔内血容积指数）850 1000 ml/m2ELWI*（血管外肺水指数）3.0 7.0 ml/kgPVPI*（肺血管通透性指数）1.0 3.0 SVV（每搏量变异）10%PPV（脉压变异）10%GEF（全心射血分数）25 35%CFI（心功能指数）4.5 6.5 1/minMAP（平均动脉压）70 90 mmHgSVRI（全身血管阻力指数）1700 2400 dyn*s*cm-5*m2,15,PiCCO 血流动力容量管理决策树,
21、CI(l/min/m2),GEDI(ml/m2)or ITBI(ml/m2),ELWI*(ml/kg)(slowly responding),3.0,3.0,700850,700850,700850,700850,ELWI(ml/kg),GEDI(ml/m2)or ITBI(ml/m2),CFI(1/min)or GEF(%),10,10,10,10,10,10,10,10,V+,V+!,V+!,V+,Cat,Cat,OK!,V-,700850,700-800850-1000,4.525,5.530,4.525,700-800 850-1000,Cat,5.530,700850,700-800 850-1000,700-800 850-1000,10,10,10,10,V-,V+=增加容量(!=慎重),V-=减少容量,Cat=儿茶酚胺心血管药物,*SVV 只能用于没有心律失常的完全机械通气病人,700850,10,Optimise to SVV*(%),10,10,10,测量结果,目标,治疗,1.,2.,10,10,10,10,
