7围术期目标导向液体治疗-2说课材料.ppt

围术期目标导向液体治疗 进展与争议;目标导向液体治疗;GDT概念;GDT历史;GDT历史;GDT历史;GDT核心;-40;小结1;GDT决策指标;8-12mmHg;传统指标HR;传统指标MAP;传统指标UOP;传统指标CVP与PAWP;传统指标CVP与PAWP;基于血流的参数;基于血流的参数;动脉波形描记;Intensive Care Med. 2007 Jan;33(1):96-103. Ann Card Anaesth. 2008 Jan-Jun;11(1):27-34. Crit Care. 2005;9(6):R687-93. ;食道多普勒超声;电阻抗;基于变异的参数;SVV和PPV;PVI和ΔPOP;基于组织灌注水平的参数;血乳酸与碱剩余;SvO2和ScvO2;胃黏膜pH;基于心脏功效参数;基于心脏功效参数;基于心脏功效参数;基于心脏功效参数;基于心脏功效参数;基于心脏功效参数;基于心脏功效参数;基于心脏功效参数;基于心脏功效参数;小结2 GDT决策指标;小结2 GDT决策指标;常用决策树; 心衰患者：TEE;低风险手术补液方案;方案1;否;中高风险手术补液方案;方案2*;监测每搏量SV;方案3;监测SVV或PPV;方案4;否;方案5*;GDT组 （通气8ml/kg）;方案6*;常规补液流程 改自St. George’s;二、目标导向液体治疗研究进展;临床研究现状;心脏手术中GDT的应用;P?l?nen P, Ruokonen E, Hippel?inen M, P?yh?nen M, Takala J. A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg. 2000 May;90(5):1052-9.;McKendry M. Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ (Clin Res Ed) 2004;329(7460):258–60.;Kapoor PM, Kakani M, Chowdhury U, Choudhury M, Lakshmy, Kiran U. Early goal-directed therapy in moderate to high-risk cardiac surgery patients. Ann Card Anaesth. 2008 Jan-Jun;11(1):27-34.;Smetkin AA, Kirov MY, Kuzkov VV, Lenkin AI, Eremeev AV, Slastilin VY, Borodin VV, Bjertnaes LJ. Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off-pump coronary surgery. Acta Anaesthesiol Scand. 2009 Apr;53(4):505-14.;Giglio M, Dalfino L, Puntillo F, Rubino G, Marucci M, Brienza N. Haemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):878-87.;;Aya HD, Cecconi M, Hamilton M, Rhodes A. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2013 Apr;110(4):510-7.;GDT在成人非心脏手术中的应用;与GDT相关死亡降低只见于极高风险组;并发症结果表明：通过一个明确规范的EGDT，极高风险手术患者受益最大。;Arulkumaran N, Corred