Department of Intensive Care Medicine, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK.
Crit Care. 2009;13(5):231. doi: 10.1186/cc8039. Epub 2009 Oct 26.
A small group of patients account for the majority of peri-operative morbidity and mortality. These 'high-risk' patients have a poor outcome due to their inability to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri-operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at any point during the peri-operative period, the outcomes of these patients can be improved. This goal directed therapy includes the use of fluid loading and inotropes, in order to optimize the preload, contractility and afterload of the heart whilst maintaining an adequate coronary perfusion pressure. Despite the benefits seen, it remains a challenge to implement this management due to difficulties in identifying these patients, scepticism and lack of critical care resources.
一小部分患者占围手术期发病率和死亡率的大多数。这些“高危”患者由于无法满足手术期间对其产生的氧输送需求，导致预后较差。已经表明，在围手术期的任何时间点针对特定的血流动力学和氧输送目标进行治疗，可以改善这些患者的结局。这种靶向治疗包括使用液体负荷和正性肌力药，以优化心脏的前负荷、收缩性和后负荷，同时保持足够的冠状动脉灌注压。尽管已经看到了这些好处，但由于难以识别这些患者、存在怀疑态度以及缺乏重症监护资源，因此实施这种管理仍然具有挑战性。
