术中血压的影响因素(双语)[精选].pptVIP

Both the severity and duration of intraoperative arterial hypotension have been identified as significant risk factors for predicting surgical mortality. 术中低血压的严重程度和持续时间都已经确定为预测手术死亡率重要的危险因素。 Particularly in elderly patients , delayed or inadequate correction of hypotension comprises nearly 40% of substandard intraoperative care and is closely associated with postoperative myocardial ischemia and infarction 尤其对于老年人，延迟纠正低血压或纠正不足约占不合格的术中护理的近40 ％，并和术后心肌缺血和梗死密切相关。 A decrease in blood pressure warrants a noninvasive assessment of cardiac output whether by end-tidal CO2, arterial waveform pulse contour analysis, or echocardiography. 对于血压下降，可通过是如是否获得呼气末二氧化碳，动脉波形分析，或超声心动图对心输出量进行无创评估。 Assuming constant minute ventilation and no exogenous source of CO2, a sudden drop in end-tidal CO2 by 3-4mmHg reflects a reduction in cardiac output by approximately 1 L/min/m2 . 如果分钟通气量恒定而且没有外部来源的二氧化碳，呼气末二氧化碳突然下降3-4mmHg反映心输出量减少大约1 L/min/m2 。 A decrease in blood pressure with no change in end-tidal CO2 indicates a primary problem with systemic vascular resistance which can be readily treated with an alpha-agonist drug. 血压下降而呼末二氧化碳没有变化表示主要的问题是体循环血管阻力下降，这可以通过使用α受体激动药来治疗。 A decrease in both blood pressure and end-tidal CO2 indicates a primary problem with cardiac output which, in turn, depends on heart rate and stroke volume. 血压和呼末二氧化碳均下降表示心输出量的下降，心输出量取决于心率和每搏输出量。 In the hypotensive patient in normal sinus rhythm and with a reduction in end-tidal CO2 , the next consideration is stroke volume which represents the difference between end-diastolic volume and end-systolic volume. 在低血压同时有正常的窦性心律的病例中，若出现呼气末二氧化碳减少，则应考虑的是每搏输出量，这代表舒张末期容积和收缩末期容积之间的差异。 While assessing preload (end-diastolic volume), dynamic indices such as pulse pressure variability or systolic pressure variability with positive pressure ventilation are sensitive indicators. End-diastolic volume is also affected by afterload and contractility. 评估前负荷（舒张末容积）时，动态的指标如脉搏压力变异性或正压通气时收缩压变异性是敏感的指标。舒张末容积也受后负荷和心肌收缩力的影响。 Afterload represents all f