Moore F A, Haenel J B, Moore E E
University of Colorado Health Science Center, Denver.
Surg Clin North Am. 1991 Aug;71(4):699-721. doi: 10.1016/s0039-6109(16)45481-2.
When we are concerned about the adequacy of peripheral oxygen delivery, our monitoring efforts focus on cardiac output as the component easiest to manipulate. Thermodilution is the current method of determining cardiac output because of logistic convenience, but by no means should it be considered the gold standard. Thoracic electrical bioimpedance is an appealing alternative because of its simplicity, noninvasiveness, and ability to track physiologic trends, but there have been a number of warnings against relying on it exclusively, at least until it is further developed. Doppler ultrasound appears to be a valid method in skilled hands, but its accuracy in quantitating cardiac output, especially in the critically ill, remains questionable. Mixed venous oximetry and transcutaneous oxygen monitoring are promising but are still being evaluated.
当我们关注外周氧输送是否充足时，我们的监测工作重点是心输出量，因为它是最易于控制的因素。由于操作简便，热稀释法是目前测定心输出量的方法，但绝不能将其视为金标准。胸部电阻抗法因其简单、无创以及能够追踪生理趋势而颇具吸引力，但已有多项警告指出，至少在其进一步发展之前，不应完全依赖该方法。在技术熟练的人员操作下，多普勒超声似乎是一种有效的方法，但其在心输出量定量方面的准确性，尤其是在危重症患者中，仍存在疑问。混合静脉血氧饱和度测定法和经皮氧监测很有前景，但仍在评估之中。
