anesthesialogy - hypovolumic
TRANSCRIPT
-
7/30/2019 Anesthesialogy - Hypovolumic
1/81
:
, , .
-
7/30/2019 Anesthesialogy - Hypovolumic
2/81
-
7/30/2019 Anesthesialogy - Hypovolumic
3/81
,,:
, ;
,
- , , ;
;
, ,;
-
7/30/2019 Anesthesialogy - Hypovolumic
4/81
,
-
7/30/2019 Anesthesialogy - Hypovolumic
5/81
, 1500,0
, 3000,0 4000,0
, 1500,0
, 3000,0
, 300,0 400,0
~ 10 000,0
-
7/30/2019 Anesthesialogy - Hypovolumic
6/81
8 30
.
http://dic.academic.ru/pictures/enc_medicine/0232045297.jpg -
7/30/2019 Anesthesialogy - Hypovolumic
7/81
;
;
- ( );
- ;
;
;
-
7/30/2019 Anesthesialogy - Hypovolumic
8/81
;
;
; per rectum;
;
-
7/30/2019 Anesthesialogy - Hypovolumic
9/81
-
7/30/2019 Anesthesialogy - Hypovolumic
10/81
Na c(/)C -
130 150NN
N
++++++
,
< 130< NN
/
++
++++++
150 > N> NN < N
/
+++
-
7/30/2019 Anesthesialogy - Hypovolumic
11/81
(%)
(/)
5
50
10
100
15
150
1
-
7/30/2019 Anesthesialogy - Hypovolumic
12/81
N
N
N
N
,
2
-
7/30/2019 Anesthesialogy - Hypovolumic
13/81
()
/
3 4
N
C
/
4 5
C
5
3
-
7/30/2019 Anesthesialogy - Hypovolumic
14/81
.
N
1.020
-
+ / -
1.020 1.030
+
1.030
++
4
-
7/30/2019 Anesthesialogy - Hypovolumic
15/81
:
20-40% ;
;
;
;
;
,
-
7/30/2019 Anesthesialogy - Hypovolumic
16/81
, .
: > 20 : 1
-
7/30/2019 Anesthesialogy - Hypovolumic
17/81
,
-
7/30/2019 Anesthesialogy - Hypovolumic
18/81
A
,
-
7/30/2019 Anesthesialogy - Hypovolumic
19/81
-
A
--
a
,
,
, ,
,
-
C
-
-
7/30/2019 Anesthesialogy - Hypovolumic
20/81
,
-
,
A
A
-
7/30/2019 Anesthesialogy - Hypovolumic
21/81
2
-
7/30/2019 Anesthesialogy - Hypovolumic
22/81
, ,
.
-
7/30/2019 Anesthesialogy - Hypovolumic
23/81
1. ;
2. . ();
3. .
-
7/30/2019 Anesthesialogy - Hypovolumic
24/81
?
-
7/30/2019 Anesthesialogy - Hypovolumic
25/81
-
:
-
7/30/2019 Anesthesialogy - Hypovolumic
26/81
0
10
20
30
40
50
60
70
80
90
100
0,5 2 4 6 8 10 12
/
,%
-
7/30/2019 Anesthesialogy - Hypovolumic
27/81
(>0,>, >);
;
;
;
-
7/30/2019 Anesthesialogy - Hypovolumic
28/81
( )
(65 - 70%)
-
-
7/30/2019 Anesthesialogy - Hypovolumic
29/81
50%
27%
-
7/30/2019 Anesthesialogy - Hypovolumic
30/81
3
-
7/30/2019 Anesthesialogy - Hypovolumic
31/81
1 2 3 4
() 2.0
(%) 40%
WHO, 2001
-
7/30/2019 Anesthesialogy - Hypovolumic
32/81
(W. B. Saunders, 1982)
(%)
1 15
2 20-25
3 ,
30-40
4 - > 40
-
7/30/2019 Anesthesialogy - Hypovolumic
33/81
I II III IV
(ml) 2000
(%) 40%
(/min) 100 >120 >140
(bpm) 1420 2030 3040 >35
>30 2030 515 Negligible
Crit Care. 2004; 8(5): 373381.
( 1997)
-
7/30/2019 Anesthesialogy - Hypovolumic
34/81
( )
(%)
> 3,5 > 60
2,13,5 4660
1,12,0 3045
0,51,0 < 30
(..,1997)
-
7/30/2019 Anesthesialogy - Hypovolumic
35/81
- , , , ( )
- , , ( 5-10% ; 0,5 ) ( 11-20% ; 0,6-1,0 ) ( 21-40% ; 1.1-2,0 ) ( 41-70% ; 2,1-3,5 )
( 71% ; 3,5 )
( 30% , ; ( 31-45% ; ( 46-60%, ) ( 61%, ) , , ,
( .. ,2000 )
-
7/30/2019 Anesthesialogy - Hypovolumic
36/81
( ) :
( .., 2003 ):
1,5 - 2,0
1,0 - 1,5
:
0,4- 1,0
0,2- 1,3
0,4- 1,3
0,3- 0,6
1,0- 4,0
5,0- 20,0 0,2- 1,0
0,3- 1,5
0,8 - 2,5
1,5 - 2,5
-
7/30/2019 Anesthesialogy - Hypovolumic
37/81
2
-
7/30/2019 Anesthesialogy - Hypovolumic
38/81
-
7/30/2019 Anesthesialogy - Hypovolumic
39/81
( 30 30 ) ,
.
:
,
..
-
7/30/2019 Anesthesialogy - Hypovolumic
40/81
;
;
-
7/30/2019 Anesthesialogy - Hypovolumic
41/81
:
, ,:
- :
, ,, , ,,
:
, , :,
-
7/30/2019 Anesthesialogy - Hypovolumic
42/81
3.
-
7/30/2019 Anesthesialogy - Hypovolumic
43/81
+
-
7/30/2019 Anesthesialogy - Hypovolumic
44/81
(!);
// ;
;
(,);
;
( , , /, .);
-
7/30/2019 Anesthesialogy - Hypovolumic
45/81
-
7/30/2019 Anesthesialogy - Hypovolumic
46/81
Cell-Saver
-
7/30/2019 Anesthesialogy - Hypovolumic
47/81
1. ;
2.
3. , (ell-saver);
4. ;
5.
-
7/30/2019 Anesthesialogy - Hypovolumic
48/81
XIV - 1667
15- .
-
7/30/2019 Anesthesialogy - Hypovolumic
49/81
;
.
-
7/30/2019 Anesthesialogy - Hypovolumic
50/81
Hb Ht ,
.
,,
.
-
7/30/2019 Anesthesialogy - Hypovolumic
51/81
Hb
(, )
1950 . - 100 / 19511980 . - 8090 /
1980 . - 70 /
-
7/30/2019 Anesthesialogy - Hypovolumic
52/81
B|BRAUNPVR-1.0 14
DO2
DO2
DO2
-
7/30/2019 Anesthesialogy - Hypovolumic
53/81
( DO2)
0
20
40
60
80
100
120
140
10 20 30 40 50 60 70 80
:
%, Ht
%
Sunder-Plassman et al., Anaesthesist 20 (1971) 172B|BRAUNPVR-1.0 26
:
48 .
APACHE II
100
80
60
40
20
0
(%)
10.3
18.8
100
< 10%
11-20%
> 20%
J. A. Lowell et al., Crit. Care. Med. 18 (1990) 728-
733
p < 0.008 B C AA B C
-
7/30/2019 Anesthesialogy - Hypovolumic
54/81
-
7/30/2019 Anesthesialogy - Hypovolumic
55/81
( 70 )
% .-
-
10%, 20%
-
-
2000
> 40 1500-2000
1500-
2000
1200-
1500
200-300 400-600 4-6 .
-
7/30/2019 Anesthesialogy - Hypovolumic
56/81
.
25 - 30 %
( , , , ,,).
.
-
7/30/2019 Anesthesialogy - Hypovolumic
57/81
:
;
;
;
;
:
;
;
;
-
7/30/2019 Anesthesialogy - Hypovolumic
58/81
-
-
7/30/2019 Anesthesialogy - Hypovolumic
59/81
30 - 50 /
() (M,G,E) 9 - 15 /
(I, II, VII, IX) 100%
(VIII:,V) 70%
(III, , S)
70%
(250 ) :
0,75
VIII: 150 III 150
-
7/30/2019 Anesthesialogy - Hypovolumic
60/81
.
.
;
;
;
-
7/30/2019 Anesthesialogy - Hypovolumic
61/81
( );
100
*109
/;
-
7/30/2019 Anesthesialogy - Hypovolumic
62/81
;
24 ;
;
-
7/30/2019 Anesthesialogy - Hypovolumic
63/81
25 -
30% ,
70 - 80 / 25%
363 25 2002 .
(
) ,
,
.
D. Stainsby, . MacLennan, P. J. Hamilton
British Journal of Anaesthesia, 2000
-
7/30/2019 Anesthesialogy - Hypovolumic
64/81
:
(1-2 4-5 ) (1
200 );
(4-5 1
) (1 50 );
Kovesi T., Royston D. Vox Sang., 2003
R.D. Miller Millers Anesthesia, 2005
-
7/30/2019 Anesthesialogy - Hypovolumic
65/81
1/;
2 10
:
Stainsby D., MacLennan ., Hamilton P. J., 2000;
Survey A. et al., 2003; Miller R.D. 2005
-
7/30/2019 Anesthesialogy - Hypovolumic
66/81
-
;
/ 200-500 . ,
/ 2.500.000 /;
:
Beck K.H. et al., 2000; Kitchens C.S., 2004
-
7/30/2019 Anesthesialogy - Hypovolumic
67/81
33-
67% 42-88% (Barrons R.W., Jahr J.S., 1996; Cvachovec K. et al.,2001; Biswas A.K. et al., 2001; Kyriss T. et al., 2001; Samama C. M. et al.,
2002);
(Erber W.N., 2002; BaronsR.W., Jahr J.S.,1996);
: 50% - 500 000 (.., 2001);
-
7/30/2019 Anesthesialogy - Hypovolumic
68/81
( ).
.
.
(- ).
.
-
7/30/2019 Anesthesialogy - Hypovolumic
69/81
-
7/30/2019 Anesthesialogy - Hypovolumic
70/81
7,2-7,5% - NaCl (4-6 /) ;
;
;U.Kreimeier,1995
-
7/30/2019 Anesthesialogy - Hypovolumic
71/81
NaCl ( 7,5%)
7,5% -NaCL
7,2% Na Cl+
7,5% Na Cl+ -70
7,5% Na Cl+ -40
( )
/
-
7/30/2019 Anesthesialogy - Hypovolumic
72/81
/ .
0
20
40
60
80
100
120
0 20 60 120
. .
(4 /)
HyperHAES 250 ml
-
7/30/2019 Anesthesialogy - Hypovolumic
73/81
HyperHAES 250 ml
- - 7.
2 % NaCl + 6 % HES 200 / 0.5
: 2464 mosmol / l
250 ml 7.2 % NaCl/ 10 % HES 200 / 0.5
1,750 ml
700 %
Frey, Messmer: AINS 1998; 33: 274 - 277
-
7/30/2019 Anesthesialogy - Hypovolumic
74/81
75 , 40 100 ,
1 ; 250
, , ,
-
7/30/2019 Anesthesialogy - Hypovolumic
75/81
, , ,
- .
-
7/30/2019 Anesthesialogy - Hypovolumic
76/81
1. 250
-
7/30/2019 Anesthesialogy - Hypovolumic
77/81
1. 250 , 1200 400 . ;
2. 90 120 .
3. , - (,.) .
4. , 6-20% .
-
7/30/2019 Anesthesialogy - Hypovolumic
78/81
:
50% (. ) ();
60-70 /, 20-25% ();
80-90 / , ();
60-70 /, , , ();
-
7/30/2019 Anesthesialogy - Hypovolumic
79/81
:
25-30% ();
0,8 /();
60% ();
1,8 ();
.
10-20 /.
-
7/30/2019 Anesthesialogy - Hypovolumic
80/81
:
52 / ();
25 / ();
( ).
, () 4 %.
-
7/30/2019 Anesthesialogy - Hypovolumic
81/81
,
, ,
.
,
.