Aya Hollmann D, Cecconi Maurizio, Rhodes Andrew
St George's Healthcare NHS Trust and St George's University of London, UK.
Turk J Anaesthesiol Reanim. 2014 Apr;42(2):56-65. doi: 10.5152/TJAR.2014.2220141. Epub 2014 Apr 1.
During the latest years, a number of studies have confirmed the benefits of perioperative haemodynamic optimisation on surgical mortality and postoperative complication rate. This process requires the use of advanced haemodynamic monitoring with the purpose of guiding therapies to reach predefined goals. This review aim to present recent evidence on perioperative goal directed therapy (GDT), with an emphasis in some aspects that may merit further investigation. In order to maximise the benefits on outcomes, GDT must be implemented as early as possible; intravascular volume optimisation should be in accordance with the response of the preload-reserve, goals should be individualised and adequacy of the intervention must be also assessed; non-invasive or minimally invasive monitoring should be used and, finally, side effects of every therapy should be taken into account in order to avoid undesired complications. New drugs and technologies, particularly those exploring the venous side of the circulation, may improve in the future the effectiveness and facilitate the implementation of this group of therapeutic interventions.
近年来，多项研究证实了围手术期血流动力学优化对手术死亡率和术后并发症发生率的益处。这一过程需要使用先进的血流动力学监测手段，以指导治疗达到预定目标。本综述旨在介绍围手术期目标导向治疗（GDT）的最新证据，并着重探讨一些可能值得进一步研究的方面。为了使对结局的益处最大化，GDT必须尽早实施；血管内容量优化应根据前负荷储备的反应进行，目标应个体化，且必须评估干预的充分性；应使用非侵入性或微创监测，最后，应考虑每种治疗的副作用以避免不良并发症。新的药物和技术，特别是那些探索循环静脉侧的药物和技术，未来可能会提高这组治疗干预措施的有效性并便于其实施。
