液体治疗与容量监测__培训课件.ppt

* 万汶可能是通过物理作用，和生物化学作用的双重途径共同作用于机体，从而有效改善毛细血管渗漏的。 * 在改善微循环灌注方面，万汶积累了大量的证据。这些证据有的以动物模型为研究对象，有的以患者为研究对象，但均表明万汶能有效改善微循环/组织灌注、抑制炎症反应、减少毛细血管渗漏。 * interstitial fluid volume (IsFV) ，circulating plasma volume (CPV) * * BACKGROUND: Improved postoperative outcome has been demonstrated by perioperative maximization of cardiac stroke volume (SV) with fluid challenges, so-called goal-directed therapy. Oesophageal Doppler (OD) has been the most common technique for goal-directed therapy, but other flow-related techniques and parameters are available and they are potentially easier to apply in clinical practice. The objective of this investigation was therefore to use OD for preoperative SV maximization and compare the findings with a Modelflow determined SV, with an OD estimated corrected flow time (FTc), with central venous oxygenation ( Svo2 ) and with muscle and brain oxygenation assessed with near infrared spectroscopy (NIRS). METHODS: Twelve patients scheduled for radical prostatectomy were anaesthetized before optimization of SV estimated by OD. A fluid challenge of 200 ml colloid was provided and repeated if at least a 10% increment in OD SV was obtained. Values were compared with simultaneously measured values of Modelflow SV, FTc, Svo2 and muscle and cerebral oxygenation estimated by NIRS. RESULTS: Based upon OD assessment, optimization of SV was achieved after the administration of 400-800 ml (mean 483 ml) of colloid. The hypothetical volumes administered for optimization based upon Modelflow and Svo2 differed from OD in 10 and 11 patients, respectively. Changes in FTc and NIRS were inconsistent with OD guided optimization. CONCLUSION: Preoperative SV optimization guided by OD for goal-directed therapy is preferable compared with Modelflow SV, FTc, NIRS and Svo2 until outcome studies for the latter are available. * BACKGROUND: In order to avoid peri-operative hypovolaemia or fluid overload, goal-directed therapy with individual maximization of flow-related haemodynamic