围术期微创监测心输出量方法的进展和临床评价.pdfVIP

围术期微创监测心输出量方法的进展和临床评价 周颖 王珊娟 杭燕南 背景围术期心输出量 (cardiacoutput，CO)监测是反映心脏功能的重要参数之一。近年来随着计算机软件的发 展，微创监测CO的方法越来越受到关注。 目的将围术期微创CO监测方法的新进展进行综述，客观评价其在围术期血流 动力学监测的作用。内容概述微创CO监测方法FloTrac/Vigileo系统监测CO、脉波指示剂连续心输出量监测 （pulse-indicator continuouscardiacoutput，PiCCO）、Modelflow模型用于CO监测的基本原理，例举临床研究对比它们与Swan-Ganz导管有创CO 监测法和TEE无创CO监测法的准确性，客观评价3种方法的优势与局限性。趋向围术期微创心输出量监测方法简便安 全、创伤较小、准确性高并能连续测定CO及相关的血流动力学指标，及时反映心血管系统状态并指导和治疗重危患者的麻醉 与围术期处理，有利于临床应用和开展。 心输出量； 动脉脉搏波形；温度稀释；Modelilow模型 Clinicalevaluationandadvancementofperioperativeminimally-invasivecardiacoutputmonitoringmethods ZHOU Ying WANGShan-juanHANGYan-nan. DepartmentofAnesthesiology,RenjiHospital,ShanghaiJiaotongUniversity, Shanghai200001,China Background Perioperativecardiacoutput(CO)monitoringofcriticalpatientsisoneoftheobjectiveindicators ofcardiacfunctions.Inrecentyears,alongwiththedevelopmentofsoftware,perioperativeminimally-invasivecardiacoutput monitoringmethodsgetmoreandmoreattractive. Objective Tosummarizethenewprogressofperioperativeminimally-invasive cardiacoutputmonitoringandobjectivelyevaluatetheirroleofperioperativehemodynamicmonitoring. Content Thebasic principleofperioperativeminimally-invasivecardiacoutputmonitoringmethods(FTV,PiCCOandModelflow)weresummedup. Enumeratetheclinicalresearchtocomparetheiraccuracywithinvasive(Swan-Ganz)ornon-invasive(TEE)cardiacoutputmonitoring methods.Estimatetheadvantagesandlimitationsofthreemethods. Trend Perioperativeminimally-invasivecardiacoutput monitoringmethodsaresimpleandsafe,lesstrauma,highaccuracyandcancontinuouslyrecordcardiacoutputandrelated hemodynamicparameters.Perioperativeminimally-invasivecardiacoutputmonitoringreflectthestateofthecardiovascularsystem promptlyandeffectivelyguidetherapyincriticalpatientsundergoinganesthesia.Itwillbemoreimportantandwidelyusedinthe future. Cardiacoutput; Arterialpulsewave; Thermodilution; Modelflowmodel 10.3760/cma.j.issn.1673-4378.2011.06.019 200001，上海