Gouveia Veronica, Marcelino Paulo, Reuter Daniel A
Department of Anesthesiology and Intensive Care Medicine, Klinikum Itzehoe, Germany.
Curr Cardiol Rev. 2011 Aug;7(3):184-96. doi: 10.2174/157340311798220511.
The goal of hemodynamic monitoring and management during major surgery is to guarantee adequate organ perfusion, a major prerequisite for adequate tissue oxygenation and thus, end-organ function. Further, hemodynamic monitoring should serve to prevent, detect, and to effectively guide treatment of potentially life-threatening hemodynamic events, such as severe hypovolemia due to hemorrhage, or cardiac failure. The ideal monitoring device does not exist, but some conditions must be met: it should be easy and operator-independently to use; it should provide adequate, reproducible information in real time. In this review we discuss in particular the role of intraoperative use of transesophageal echocardiography (TOE). Although TOE has gained special relevance in cardiac surgery, its role in major non cardiac surgery is still to be determined. We particularly focus on its ability to provide measurements of cardiac output (CO), and its role to guide fluid therapy. Within the last decade, concepts oriented on optimizing stroke volume and cardiac output mainly by fluid administration and guided by continuous monitoring of cardiac output or so called functional parameters of cardiac preload gained particular attention. Although they are potentially linked to an increased amount of fluid infusion, recent data give evidence that such pre-emptive concepts of hemodynamic optimization result in a decrease in morbidity and mortality. As TOE allows a real time direct visualization of cardiac structures, other potentially important advantages of its use also outside the cardiac surgery operation room can be postulated, namely the ability to evaluate the anatomical and functional integrity of the left and the right heart chambers. Finally, a practical approach to TOE monitoring is presented, based on a local experience.
大手术期间血流动力学监测与管理的目标是确保充足的器官灌注，这是实现充足组织氧合以及终末器官功能的主要前提条件。此外，血流动力学监测应有助于预防、检测并有效指导对潜在危及生命的血流动力学事件的治疗，例如因出血导致的严重低血容量或心力衰竭。理想的监测设备并不存在，但必须满足一些条件：它应易于操作且不依赖操作人员；应能实时提供充分、可重复的信息。在本综述中，我们特别讨论术中使用经食管超声心动图（TOE）的作用。尽管TOE在心脏手术中具有特殊意义，但其在非心脏大手术中的作用仍有待确定。我们特别关注其测量心输出量（CO）的能力及其在指导液体治疗方面的作用。在过去十年中，主要通过液体输注并在持续监测心输出量或所谓心脏前负荷功能参数的指导下优化每搏输出量和心输出量的理念受到了特别关注。尽管它们可能与液体输注量增加有关，但最近的数据表明，这种血流动力学优化的前瞻性理念可降低发病率和死亡率。由于TOE能够实时直接观察心脏结构，因此可以推测其在心脏手术室外使用还具有其他潜在的重要优势，即能够评估左右心腔的解剖和功能完整性。最后，基于当地经验介绍了一种TOE监测的实用方法。
