心脏外科围术期的重症监护

doi:10.16139/j.1007-9610.2023.05.03

摘要/Abstract

摘要：

心脏外科围术期重症监护的快速发展显著提高了接受心脏大血管手术病人的预后。在血流动力学领域，除传统的各类动脉导管和中心静脉导管，热稀释法与超声心动图正逐步成为常规的血流动力学监测技术，但其临床价值有待进一步研究。同时，优化组织微循环，以满足机体的氧气和代谢需求，成为血流动力学复苏的目标。针对心脏外科围术期V-A 体外膜肺氧合的管理依赖于持续的血流动力学监测。容量管理、血管活性药物及舒张药物、强心药等药物治疗仍是重点。此外，多种机械循环辅助装置为终末期心力衰竭和严重心肺衰竭的病人带来不同的治疗方式和希望。

关键词: 重症监护, 心脏外科, 血流动力学, 机械循环

Abstract:

The rapid development of perioperative intensive care in cardiac surgery has greatly improved the prognosis for patients undergoing major cardiovascular surgery. In the field of hemodynamics, besides traditional methods, such as a variety of arterial catheters and central venous catheter, thermodilution and echocardiography have gradually becoming routines in hemodynamic monitoring, but their clinical values require further investigation. At the same time, optimizing micro-circulation, in order to meet the demand of oxygen and metabolism, is the goal of hemodynamic resuscitation. The management of V-A extracorporeal membrane oxygenation (ECMO) in the perioperative period of cardiac surgery depends on persistent hemodynamic monitoring. Volume management, vasoactive drugs, inotropes and vasodilators are still keys in pharmacological management. In addition, many mechanical circulatory assist devices have brought more treatments and hope for end-stage heart failure and severe cardiopulmonary dysfunction.

Key words: Intensive care, Cardiac surgery, Hemodynamics, Mechanical circulatory

中图分类号:

刘华, 罗明豪, 屠国伟, 罗哲. 心脏外科围术期的重症监护[J]. 外科理论与实践, 2023, 28(05): 409-414.

LIU Hua, LUO Minghao, TU Guowei, LUO Zhe. Perioperative intensive care for cardiac surgery patients[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 409-414.

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