国际麻醉学与复苏杂志   2014, Issue (12): 6-6
    
围术期循环容量监测的动态指标及其研究进展
王朔, 韩如泉1()
1.首都医科大学附属北京天坛医院
Progress in dynamic variables for perioperative fluid volume monitoring
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摘要:

背景 大量研究表明围术期加强循环容量监测、目标导向液体治疗(goal?蛳directed fluid therapy, GDT)可以减少术后并发症,改善患者预后。每搏输出量变异度(stroke volume variation, SVV)、脉压差变异度(pulse pressure variation, PPV)、脉搏灌注变异指数(pleth variability index, PVI)、PPV/SVV比值等动态指标可以预测容量反应性,指导患者容量治疗的能力优于静态指标。 目的 探讨动态参数指导容量治疗的可靠性和影响因素。 内容 动态指标易受潮气量、血管张力、体位等多种因素影响,而且患者心律失常、非机械通气时动态参数没有应用价值。另外,容量治疗的目标是保证组织灌注和氧供,不能单纯依靠某一参数变化进行评价。因此,应结合患者其他血流动力学参数、相关实验室指标及临床转归等综合判断。 趋向 动态指标对预测液体治疗效果具有很好的指导意义和广阔的应用前景,其对脑组织等灌注的评估能力仍需进一步研究。

关键词: 循环容量; 监测; 动态指标; 液体治疗; 组织灌注; 转归
Abstract:

Background Numerous studies have demonstrated that goal?蛳directed fluid therapy(GDT) is contributed to decreasing postoperative complications and improving clinical outcome. Dynamic variables, such as stroke volume variation(SVV), pulse pressure variation(PPV), pleth variability index(PVI) and PPV/SVV, have been shown to be reliable predictors of fluid responsiveness in mechanically ventilated patients under general anesthesia. They are superior to static variables in guiding perioperative fluid management. Objective To discuss the reliability and influencing factors of dynamic variables in goal?蛳directed fluid therapy. Content Dynamic variables can be significantly influenced by tidal volume, vascular tone and patient position. Besides, the ultimate aim of fluid therapy is ensuring optimal tissue perfusion and oxygenation for patients rather than improving any variable. Therefore, dynamic variables can be made increasingly more sensitive and specific if combined to other hemodynamic variables, relevant laboratory results and prognosis. Trend Dynamic variables have broad application prospects in guiding perioperative fluid management. However, the ability of dynamic variables in evaluating organ perfusion still needs further research.

Key words: Cirulating blood volume; Monitoring; Dynamic variables; Fluid therapy; Tissue perfusion; Prognosis