Tolstova I A, Aksel'rod B A, Shmyrin M M, Iavorovskiĭ A G
Anesteziol Reanimatol. 2009 Sep-Oct(5):13-7.
The paper analyzes goal-oriented infusion therapy used during myocardial revascularization on the working heart. Forty-seven patients with coronary heart disease were examined. Group 1 (control) (n = 20) received standard infusion therapy (a combination of colloids and crystalloids (1:1) at a rate of 6-7 ml/kg/h, by being oriented to indices, such as heart rate, blood pressure, central venous pressure, and diuresis rate. In group 2, an anesthetist was oriented to central hemodynamic parameters during infusion therapy. In addition, the patients of this group underwent the 45 degrees passive leg raising test. In this group, a volume load was done at the beginning of an operation until the maximum possible SV resulted from increased preload (global end-diastolic volume index). The goal of infusion therapy throughout the operation was to maintain these values of the latter index. Goal-oriented infusion therapy, the purpose of which was to determine and maintain the individual optimal values of preload, was found to minimize hemodynamic disorders at surgery and to reduce the frequency of use of cardiotonic agents and the duration of artificial ventilation.
本文分析了在心脏不停跳心肌血运重建术中使用的目标导向性输液治疗。对47例冠心病患者进行了检查。第1组（对照组）（n = 20）接受标准输液治疗（胶体液和晶体液按1:1混合，速率为6 - 7 ml/kg/h，依据心率、血压、中心静脉压和利尿速率等指标进行调整）。第2组在输液治疗期间，麻醉师依据中心血流动力学参数进行调整。此外，该组患者还进行了45度被动抬腿试验。在这组中，手术开始时进行容量负荷，直至因前负荷增加（全心舒张末期容积指数）导致最大可能的每搏输出量。整个手术过程中输液治疗的目标是维持后一项指标的这些值。目标导向性输液治疗的目的是确定并维持个体的最佳前负荷值，结果发现该治疗可使手术中的血流动力学紊乱降至最低，并减少强心剂的使用频率和人工通气的持续时间。
