课件：围术期液体治疗的进展.ppt

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，而不应对所有病人采用同样的治疗方法 THANK YOU SUCCESS * * 可编辑 术中液体治疗对术后生理功能恢复和预后的影响 32例病人，择期结肠手术 限制输液组 [median 1640 ml (range 935–2250 ml)] 自由输液组 [median 5050 ml (range 3563–8050 ml)] British Journal of Anaesthesia 99 (4): 500–8 (2007) Protocol of fluid administration and patient management British Journal of Anaesthesia 99 (4): 500–8 (2007) Effect of fluid therapy on postoperative pulmonaryfunction British Journal of Anaesthesia 99 (4): 500–8 (2007) Effect of fluid therapy on nightly postoperative hypoxaemia Postoperative data 与自由输液相比，限制输液策略 改善术后肺功能恢复 改善术后氧合状态 但有增加术后并发症的趋势 British Journal of Anaesthesia 99 (4): 500–8 (2007) 早期研究与近期研究差异? 早期围术期输液量普遍偏多，限制输液减少并发症 近期围术期输液量已经相对减少，进一步限制输液量反可能有害 液体负荷与围术期并发症的关系 液体治疗的传统观念 液体治疗过度的危害 限制性液体 “目标引导”的液体治疗 Simultaneous measurements of blood volume and CVP in 188 ICU patients No association between these two variables (r =0.27). The correlation between CVP and change in blood volume was 0.1 (r2 =0.01). Crit Care Med 1984; 12:107–112 “...CVP与血容量之间的相关关系非常差，CVP/ ΔCVP也不能预测液体冲击引起的血流动力学变化 ... CVP不应用于液体治疗的临床决策... ...我们认为在ICU、手术室和急诊室不应常规监测CVP” CHEST