Morozowich Steven T, Ramakrishna Harish
Department of Anesthesiology, Mayo Clinic, College of Medicine; Department of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, Arizona, USA.
Ann Card Anaesth. 2015 Oct-Dec;18(4):543-54. doi: 10.4103/0971-9784.166464.
Despite the growing body of evidence evaluating the efficacy of vasoactive agents in the management of hemodynamic instability and circulatory shock, it appears no agent is superior. This is becoming increasingly accepted as current guidelines are moving away from detailed algorithms for the management of shock, and instead succinctly state that vasoactive agents should be individualized and guided by invasive hemodynamic monitoring. This extends to the perioperative period, where vasoactive agent selection and use may still be left to the discretion of the treating physician with a goal-directed approach, consisting of close hemodynamic monitoring and administration of the lowest effective dose to achieve the hemodynamic goals. Successful therapy depends on the ability to rapidly diagnose the etiology of circulatory shock and thoroughly understand its pathophysiology as well as the pharmacology of vasoactive agents. This review focuses on the physiology and resuscitation goals in perioperative shock, as well as the pharmacology and recent advances in vasoactive agent use in its management.
尽管评估血管活性药物在血流动力学不稳定和循环性休克管理中疗效的证据越来越多，但似乎没有一种药物是更优的。随着当前指南不再采用详细的休克管理算法，而是简洁地指出血管活性药物应个体化并以有创血流动力学监测为指导，这一点越来越被接受。这也延伸到围手术期，在围手术期，血管活性药物的选择和使用可能仍由治疗医师根据目标导向的方法自行决定，该方法包括密切的血流动力学监测和给予最低有效剂量以实现血流动力学目标。成功的治疗取决于快速诊断循环性休克病因的能力，以及透彻理解其病理生理学和血管活性药物的药理学。本综述重点关注围手术期休克的生理学和复苏目标，以及其管理中血管活性药物使用的药理学和最新进展。
