围术期液体治疗的进展讲解课件.ppt

Critical care 2010,14:R18 Standard care protocol Critical care 2010,14:R18 Goal directed protocol Critical care 2010,14:R18 Intraoperative data Critical care 2010,14:R18 Length of hospital stay Critical care 2010,14:R18 住院时间明显缩短 Complication until hospital discharge 住院期间并发症明显减少 Critical care 2010,14:R18 目标引导液体治疗对术后恢复的影响 100例病人，择期大手术，预期出血500mL 对照组：标准液体治疗 治疗组：经食道超声多普勒?维持最佳SV Anesthesiology 2002; 97:820–6 Intraoperative fluid managementalgorithm Anesthesiology 2002; 97:820–6 Incidence of Postoperative Complications Anesthesiology 2002; 97:820–6 术后进食固体食物时间： 对照组(4.7?0.5)天 vs 治疗组(3?0.5) 天 (P=0.01) 术后住院时间： 对照组(7?3) 天 vs 治疗组(5?3)天 (P=0.03) Anesthesiology 2002; 97:820–6 目标引导液体治疗 促进胃肠功能恢复 减少PONV发生 缩短住院时间 术中经食道超声多普勒引导的液体治疗改善预后? RCT研究, 128例拟行结直肠手术病人 对照组：常规循环监护，CVP 12-15mmHg 治疗组：常规循环监护，SV监护?维持最佳SV Br J Anaesth 2005; 95: 634–42 Br J Anaesth 2005; 95: 634–42 Postoperative hospitalization and recovery of gut funtion Br J Anaesth 2005; 95: 634–42 Postoperative complication Br J Anaesth 2005; 95: 634–42 术中多普勒超声引导的液体治疗 改善胃肠道功能恢复 减少胃肠道并发症发生 缩短住院时间 Br J Anaesth 2005; 95: 634–42 5项RCT研究，420例腹部大手术病人 食道多普勒目标引导治疗 常规治疗 目标引导的围术期液体治疗改善病人预后? Anaesthesia, 2008, 63, pages 44–51 ICU admissions Anaesthesia, 2008, 63, pages 44–51 目标引导治疗减少需入ICU病人数量 Return of bowel function Anaesthesia, 2008, 63, pages 44–51 目标引导治疗加速术后胃肠道功能恢复 Overall rate of complications Anaesthesia, 2008, 63, pages 44–51 目标引导治疗减少术后并发症发生率 Hospital stay Anaesthesia, 2008, 63, pages 44–51 目标引导治疗缩短术后住院时间 Phan TD et al. J Am Coll Surg 2008; 207: 935 Decreased length of stay with GDT Phan TD et al. J Am Coll Surg 2008; 207: 935 Decreased time to resume full diet with GDT Phan TD et al. J Am Coll Surg 2008; 207: 935 Decreased morbidity with GDT Phan TD et al. J Am Coll Surg 2008; 207: 935 Average increased volume colloid 700 mL Phan TD et al. J Am Coll Surg 2008; 207: 935 亚临床的血容量不足可导致肠道功能障碍 目标引导的围术期液体治疗可减少血容量不足，预防肠道功能障碍发生 Phan TD et al. J Am Coll Surg 2008; 207: 935 小 结 输液过多或过少均对病人预后不利 目标是维持最佳血容量，避免过负荷/容量不足 应根据血流动力监测结果进行目标引导的个体化治疗，而不