机械通气患者容量反应性评估策略.pdfVIP

? 50 ? 国际呼吸杂志 2014 年 7 月第 34 卷增刊 1 lnt] Respir.Ju!y 2014 , ol._l!，~uppl. 1 .综述. 机械通气患者容量反应性评估策略 刘新秀张鲁涛阎锡新 E摘要】 对于急性循环衰竭患者，特别是感染性休克患者，液体治疗对于血流动力学的稳定、组织 器官的血流灌注、纠正细胞缺氧、对抗感染十分重要，但过多增加液体量对危重症患者，特别是除毒血症 和/或肺损伤患者是有害的，如何选取合适的指标指导临床合理输液仍面临许多挑战。评估容量反应性 可避免盲目补液，降低补液风险。回顾关于评估容量反应性的指标及临床报道，静态血流动力学参数， 如中心静脉压、肺毛细血管模压，虽常用但受干扰因素多，无法及时准确地评估循环血容量的变化。基 于心肺相互作用的功能性血流动力学监测指标，如脉压变异和每搏量变异，虽广泛应用，但因自主呼吸、 心律失常、低潮气量或低肺顺应性等局限性，不能用于所有患者。呼气末屏气试验、微量静脉输液、被动 抬腿试验成为有自主呼吸运动和/或心律失常情况下评估容量反应性的备选方法，其可靠性及局限性值 得进一步研究。 E关键词】 机械通气;容量反应性;呼气末屏气试验 p 微量静脉输液;被动抬腿试验 Assessment of volume responsiveness during mechanical ventilation Liu Xinxiu ,Zhang Lutao ,Yan Xixin. The First Department 01 Respiratory Medicine , the Second Hos户 ital 01 Hebei Medical University , Institute ο1 Res户 iratory Disease 01 Hebei Province , Shijiazhuang 050000 ,China Corresρ onding author : yα， n Xix 时 ， Email: xi_xin_yaη@163.com 1(Ab暗tract For patients with acute circulatory {ai!ure , particularly with septic shock , fluìd administration is crucial for the steady of hemodynamic and tissue oxygen consumption , but excessive fluid administration is deleterious in critically ill patients , particula r! y in case of sepsis and/or lung injury. Thus assessment of volume responsiveness before deciding to administer volume expansion is of great importance , for the purpose of avoiding blind f1 uid administration. Through reviewing all the indìcators and c1inical reports about volume responsiveness , static hemodynamic parameters , such as central venous pressure and pulmonary capillary wedge pressure , which have been used for many years , lose their predictive value because of some limitations. And functional hemodynamic monitoring indexes , such as pulse pressure variation and stroke volume variation , whìch are based on the heart-lung interactions , cannot be used ìn cases of spontaneous breathing activity , cardiac arrhythmias , low tidal volume or low lung compliance. Thus the end-expiratory occlusion ,mini fluìd challenge ,and the passive