围术期容量监测与治疗

doi:10.16139/j.1007-9610.2023.05.02

摘要/Abstract

摘要：

围术期容量监测与治疗是临床麻醉的重要组成部分，对恢复有效血容量、保证器官组织氧供、稳定内环境等必不可少，也是术后快速康复的重要组成部分。围术期合适的容量监测手段和液体治疗，能使血流动力学达到最优化，但目前术中容量监测方案仍存在争议。本文通过对围术期各种容量监测手段的特点及其临床价值进行分析和阐述，探讨围术期容量监测与治疗策略，为预防或减少术后并发症、改善预后提供理论基础。

关键词: 围术期, 容量监测, 容量治疗

Abstract:

Perioperative blood volume monitoring and treatment is an important part of clinical anesthesia, which is essential for restoring effective blood volume, ensuring oxygen supply to organs and tissues, and stabilizing the internal environment. It is also an important part of rapid recovery after surgery. Selecting appropriate blood volume monitoring methods and reasonable fluid therapy during the perioperative period can optimize the hemodynamics of patients. But there is still some controversy about the intraoperative blood volume monitoring scheme. This article intended to analyze and review the characteristics and clinical value of various perioperative blood volume monitoring methods, and explore the strategies of perioperative blood volume monitoring and treatment, so as to provide a theoretical basis for preventing or reducing postoperative complications and improving the prognosis of patients.

Key words: Perioperative period, Volume monitoring, Volume therapy

中图分类号:

R614

潘青波, 严俊, 罗艳. 围术期容量监测与治疗[J]. 外科理论与实践, 2023, 28(05): 402-408.

PAN Qingbo, YAN Jun, LUO Yan. Perioperative blood volume monitoring and therapy[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 402-408.

参考文献 29

[1]	SIMPAO A F, WU L, NELSON O, et al. Preoperative fluid fasting times and postinduction low blood pressure in children: a retrospective analysis[J]. Anesthesiology, 2020, 133(3):523-533. doi: 10.1097/ALN.0000000000003343 pmid: 32433278
[2]	TAY T Y, NORDIN N, BADARUDDIN I A, et al. A patient with third-space fluid loss[J]. Clin Chem, 2023, 69(2):125-128. doi: 10.1093/clinchem/hvac205 pmid: 36724481
[3]	MYRBERG T, LINDELÖF L, HULTIN M. Effect of preoperative fluid therapy on hemodynamic stability during anesthesia induction, a randomized study[J]. Acta Anaesthesiol Scand, 2019, 63(9):1129-1136. doi: 10.1111/aas.13419 pmid: 31240711
[4]	MESSMER A S, ZINGG C, MÜLLER M, et al. Fluid overload and mortality in adult critical care patients-a systematic review and meta-analysis of observational studies[J]. Crit Care Med, 2020, 48(12):1862-1870. doi: 10.1097/CCM.0000000000004617 pmid: 33009098
[5]	LIN W Q, WU H H, SU C S, et al. Comparison of conti-nuous noninvasive blood pressure monitoring by TL-300 with standard invasive blood pressure measurement in patients undergoing elective neurosurgery[J]. J Neurosurg Anesthesiol, 2017, 29(1):1-7. doi: 10.1097/ANA.0000000000000245 URL
[6]	ZAYAT R, DROSOS V, SCHNOERING H, et al. Radial artery tonometry to monitor blood pressure and hemodynamics in ambulatory left ventricular assist device patients in comparison with Doppler ultrasound and transthoracic echocardiography: a pilot study[J]. Artif Organs, 2019, 43(3):242-253. doi: 10.1111/aor.13335 pmid: 30040134
[7]	MAHESHWARI K, KHANNA S, BAJRACHARYA G R, et al. A randomized trial of continuous noninvasive blood pressure monitoring during noncardiac surgery[J]. Anesth Analg, 2018, 127(2):424-431. doi: 10.1213/ANE.0000000000003482 pmid: 29916861
[8]	SAUGEL B, FASSIO F, HAPFELMEIER A, et al. The T-Line TL-200 system for continuous non-invasive blood pressure measurement in medical intensive care unit patients[J]. Intensive Care Med, 2012, 38(9):1471-1477. doi: 10.1007/s00134-012-2617-x pmid: 22744376
[9]	JOOSTEN A, DESEBBE O, SUEHIRO K, et al. Accuracy and precision of non-invasive cardiac output monitoring devices in perioperative medicine: a systematic review and meta-analysis[J]. Br J Anaesth, 2017, 118(3):298-310. doi: 10.1093/bja/aew461 URL
[10]	GALARZA L, MERCADO P, TEBOUL J L, et al. Estimating the rapid haemodynamic effects of passive leg raising in critically ill patients using bioreactance[J]. Br J Anaesth, 2018, 121(3):567-573. doi: S0007-0912(18)30265-4 pmid: 30115254
[11]	HAN S, LEE J H, KIM G, et al. Bioreactance is not interchangeable with thermodilution for measuring cardiac output during adult liver transplantation[J]. PLoS One, 2015, 10(5):e0127981. doi: 10.1371/journal.pone.0127981 URL
[12]	LATHAM H E, BENGTSON C D, SATTERWHITE L, et al. Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes[J]. J Crit Care, 2017, 42:42-46. doi: S0883-9441(16)30938-8 pmid: 28672146
[13]	JØRGENSEN M R, JUHL-OLSEN P, FREDERIKSEN C A, et al. Transthoracic echocardiography in the perioperative setting[J]. Curr Opin Anesthesio, 2016, 29(1):46-54.
[14]	PIERRAKOS C, VELISSARIS D, SCOLLETTA S, et al. Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock?[J]. Intensive Care Med, 2012, 38(3):422-428. doi: 10.1007/s00134-011-2457-0 pmid: 22278593
[15]	DELLINGER R P, LEVY M M, RHODES A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012[J]. Intensive Care Med, 2013, 39(2):165-228. doi: 10.1007/s00134-012-2769-8 pmid: 23361625
[16]	MARIK P E, BARAM M, VAHID B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares[J]. Chest, 2008, 134(1):172-178. doi: 10.1378/chest.07-2331 pmid: 18628220
[17]	CECCONI M, AYA H D. Central venous pressure cannot predict fluid-responsiveness[J]. Evid Based Med, 2014, 19(2):63. doi: 10.1136/eb-2013-101496 pmid: 24132054
[18]	EGAL M, ERLER N S, DE GEUS H R, et al. Targeting oliguria reversal in goal-directed hemodynamic management does not reduce renal dysfunction in perioperative and critically ill patients: a systematic review and meta-analysis[J]. Anesth Analg, 2016, 122(1):173-185. doi: 10.1213/ANE.0000000000001027 pmid: 26505575
[19]	MIZOTA T, YAMAMOTO Y, HAMADA M, et al. Intra-operative oliguria predicts acute kidney injury after major abdominal surgery[J]. Br J Anaesth, 2017, 119(6):1127-1134. doi: 10.1093/bja/aex255 URL
[20]	TSUTSUI M, MATSUOKA N, IKEDA T, et al. Comparison of a new cardiac output ultrasound dilution method with thermodilution technique in adult patients under general anesthesia[J]. J Cardiothorac Vasc Anesth, 2009, 23(6):835-840. doi: 10.1053/j.jvca.2009.03.007 pmid: 19464193
[21]	THIELE R H, COLQUHOUN D A, BLUM F E, et al. The ability of anesthesia providers to visually estimate systolic pressure variability using the “eyeball” technique[J]. Anesth Analg, 2012, 115(1):176-181. doi: 10.1213/ANE.0b013e31824d5fa1 URL
[22]	MESSINA A, PELAIA C, BRUNI A, et al. Fluid challenge during anesthesia: a systematic review and meta-analysis[J]. Anesth Analg, 2018, 127(6):1353-1364. doi: 10.1213/ANE.0000000000003834 pmid: 30300177
[23]	GATTINONI L, BRAZZI L, PELOSI P, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients[J]. N Engl J Med, 1995, 333(16):1025-1032. doi: 10.1056/NEJM199510193331601 URL
[24]	RIVERS E, NGUYEN B, HAVSTAD S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock[J]. N Engl J Med, 2001, 345(19):1368-1377. doi: 10.1056/NEJMoa010307 URL
[25]	HAMILTON M A, CECCONI M, RHODES A. A syste-matic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients[J]. Anesth Analg, 2011, 112(6):1392-1402. doi: 10.1213/ANE.0b013e3181eeaae5 URL
[26]	CHONG M A, WANG Y, BERBENETZ N M, et al. Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes? A systematic review and meta-analysis[J]. Eur J Anaesthesiol, 2018, 35(7):469-483. doi: 10.1097/EJA.0000000000000778 URL
[27]	MYLES P S, BELLOMO R, CORCORAN T, et al. Restrictive versus liberal fluid therapy for major abdominal surgery[J]. N Engl J Med, 2018, 378(24):2263-2274. doi: 10.1056/NEJMoa1801601 URL
[28]	FURRER M A, SCHNEIDER M P, LÖFFEL L M, et al. Impact of intra-operative fluid and noradrenaline admini-stration on early postoperative renal function after cystectomy and urinary diversion: a retrospective observational cohort study[J]. Eur J Anaesthesiol, 2018, 35(9):641-649. doi: 10.1097/EJA.0000000000000808 URL
[29]	MYLES P S, ANDREWS S, NICHOLSON J, et al. Contemporary approaches to perioperative Ⅳ fluid therapy[J]. World J Surg, 2017, 41(10):2457-2463. doi: 10.1007/s00268-017-4055-y URL